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Antibiotic prophylaxis for hernia repair.

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Referencias

References to studies included in this review

Ir a:

Andersen 1980 {published data only}

Andersen JR, Burcharth F, Larsen HW, Roder O, Andersen B. Polyglycolic acid, silk, and topical ampicillin. Their use in hernia repair and cholecystectomy. Arch Surg 1980;115:293‐5.

Andersen 1980 {published data only}

Andersen JR, Burcharth F, Larsen HW, Roder O, Andersen B. Polyglycolic acid, silk, and topical ampicillin. Their use in hernia repair and cholecystectomy. Arch Surg 1980;115:293‐5.

Evans 1973 {published data only}

Evans C, Pollock AV. The reduction of surgical wound infections by prophylactic parenteral cephaloridine. A controlled clinical trial. Br J Surg 1973;60(6):434‐7.

Lazorthes 1992 {published data only}

Lazorthes F, Chiotasso P, Massip P, Materre JP, Sarkissian M. Local antibiotic prophylaxis in inguinal hernia repair. Surg Gynecol Obstet 1992;175:569‐70.

Morales 2000 {published data only}

Morales R, Carmona A, Pagán A, García Menéndez C, Bravo R, Hernández MJ, et al. Utility of antibiotic propyhylaxis in reducing wound infection in inguinal or femoral hernia repair using propypropylene mesh [Utilidad de la profilaxis antibiótica en la reducción de la infección de herida en la reparación de la hernia inguinal o crural mediante malla de prolipropileno]. Cir Esp 2000;67(1):51‐9.

Oteiza 2004 {published data only}

Oteiza F, Ciga MA, Ortiz H. Antibiotic prophylaxis in inguinal hernioplasty. [Profilaxis antibiótica en la hernioplastia inguinal.]. Cir Esp 2004;75(2):69‐71.

Platt 1990 {published data only}

Platt R, Zaleznik DF, Hopkins CC, Dellinger EP, Karchmer AW, Bryan CS, et al. Perioperative antibiotic prophylaxis for herniorrhaphy and breast surgery. N Engl J Med 1990;322(3):153‐60.

Taylor 1997 {published data only}

Taylor EW, Byrne DJ, Leaper DJ, Karran SJ, Kennedy Browne M, Mitchell KJ. Antibiotic prophylaxis and open groin hernia repair. World J Surg 1997;21(8):811‐5.

Yerdel 2001 {published data only}

Yerdel MA, Akin EB, Dolalan S, Turkcapar AG, Pehlivan M, Gecim IE, et al. Effect o single‐dose prophylactic ampicillin and sulbactam on wound infection after tension‐free inguinal hernia repair with prolypropylene mesh. The randomized, double‐blind, prospective trial. Ann Surg 2001;233(1):26‐33.

References to studies excluded from this review

Ir a:

Abo‐Rahmy 1998 {published data only}

Abo‐Rahmy E. Perioperative antibiotic prophylaxis in abdominal surgery for hernia repair: retrospective study of 1524 consecutive patients. J Chemother 1998;10(3):248‐53.

Angio 2001 {published data only}

Angio LG, Versaci A, Rivoli G, Santagati C, De Caridi G, Pacile V. The switch prophylaxis with levofloxacin in surgical procedures for prosthetic inguinal hernia repair in one day surgery. [La switch prophylaxis con levofloxacina negli interventi di ernioplastica inguinale con protesi in regime di one day surgery.]. G Chir 2001;22(8‐9):299‐302. [MEDLINE: 21540039]

Barreca 2000 {published data only}

Barreca M, Stipa F, Cardi E, Bianchini L, Lucandri G, Randone B. Antibiotic prophylaxis in the surgical treatment of inguinal hernia: need or habit? [La profilassi antibiotica nel trattamento chirurgico dell'ernia inguinale: necessità o abitudine?]. Minerva Chir 2000;55(9):599‐605.

Bozzetti 1975 {published data only}

Bozzetti F, Doci R, Milani A, Orefice S, Rasponi A, Vaglini M. Topical ampicilin and local infectious complications in oncological surgery [Ampicillina topica e complicanze infettive locali in chirurgia oncologica]. Tumori 1975;61(5):425‐32.

Dazzi 1994 {published data only}

Dazzi C, Licheri S, Sias F, Secci L, Daniele GM. Wound infection's prophylaxis with teicoplanin in major ambulatory surgery [La teicoplanina nella profilassi delle infezioni della ferita in chirurgia ambulatoriale maggiore]. Ann Ital Chir 1994;65(1):121‐3.

Escartín 1999 {published data only}

Escartín A, Pellicer MM, Elía M, Jiménez A, Arribas MD, Lagunas E, et al. Antibiotic prophylaxis in inguinal hernia repair [Profilaxis antibiótica en la cirugía de la hernia inguinal]. Cir Esp 1999;65(1):24‐7.

Gaskill 1989 {published data only}

Gaskill HV 3rd. Levine BA. A randomized prospective study of antibiotic prophylaxis during abdominal surgery. J Antimicrob Chemother 1989;23(Suppl):D79‐83.

Gervino 2000 {published data only}

Gervino L, Cangioni G, Renzi F. A retrospective study on the efficacy of short‐term perioperative prophylaxis in abdominal surgery for hernia repair in 1254 patients. J Chemother 2000;12(Suppl 3):34‐7.

Gilbert 1993 {published data only}

Gilbert AI, Felton LL. Infection in inguinal hernia repair considering biomaterials and antibiotics. Surg Gynecol Obstet 1993;177:126‐30.

Gilmore 1977 {published data only}

Gilmore OJA, Reid C, Strokon A. A study of the effect of povidone‐iodine on wound healing. Postgrad Med J 1977;53(617):122‐5.

Hair 2000 {published data only}

Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, et al. Groin hernia repair in Scotland. Br J Surg 2000;87(12):1722‐6.

Hedawoo 1995 {published data only}

Hedawoo JB, Kulkarni VM, Gundeti MS. Role of antibiotics in clean wounds. J Indian Med Assoc 1985;93(8):293‐4.

Houck 1989 {published data only}

Houck JP, Rypins EB, Sarfeh IJ, Juler GL, Shimoda KJ. Repair of incisional hernia. Surg Gynecol Obstet 1989;169:397‐9.

Karran 1992 {published data only}

Karran SJ, Karran SE, Toyn K, Brough P. Antibiotic prophylaxis in clean surgical cases and the role of community surveillance.. Eur J Surg 1992;567 Suppl:31‐2.

Lewis 1995 {published data only}

Lewis RT, Weigand FM, Mamazza J, Lloyd‐Smith W, Tataryn D. Should antibiotc prophylaxis be used routinely in clean surgical procedures: a tentative yes.. Surgery 1995;118(4):742‐7.

Lord 1977 {published data only}

Lord JW, Rossi G, Daliana M. Intraoperative antibiotic wound lavage: an attempt to eliminate postoperative infection in arterial and clean general surgical procedures.. Ann Surg 1977;185(6):634‐41.

Lord 1983 {published data only}

Lord JW. Intraoperative antibiotic wound irrigation. Surg Gynecol Obstet 1983;157(4):357‐61.

Luke 1991 {published data only}

Luke M, Iversen J, Sondergaard J, Kvist E, Lund P, Andersen F, et al. Ceftriasone vs. ampicillin + metronidazole as prophylaxis against infections after clean‐contaminated abdominal surgery. Eur J Surg 1991;157(1):45‐9.

Massaioli 1995 {published data only}

Massaioli N, Marchesa P, Bacino A, Galliano R, Borello G, Bonatti L, et al. Antibiotic prophylaxis with vancomycin in reparative surgery using alloplastic material [Antibioticoprofilassi con vancomicina nella chirurgia riparativa con materiale alloplastico.]. Minerva Chir 1995;50(9):827‐9.

Menzies 1989 {published data only}

Menzies D, Gilbert JM, Shepherd MJ, Rogers TR. A comparixon between amoxycillin/clavulanate and mezlocillin in abdominal surgical prophylaxis. J Antimicrob Chemother 1989;24(Suppl):B203‐8.

Musella 2001 {published data only}

Musella M, Guido A, Musella S. Collagen tampons as aminoglycoside carriers to reduce postoperative infection rate in prosthetic repair of groin hernias. Eur J Surg 2001;167(2):130‐2.

Nundy 1983 {published data only}

Nundy S, Ramachandran K. The place of antibiotics in preventing wound infection after clean operations in an Indian hospital: a propsective, randomised, controlled clinical trial.. Ann R Coll Surg Engl 1983;65:400‐2.

Platt 1992 {published data only}

Platt R, Zucker JR, Zaleznik DF, Hopkins CC, Dellinger EP, Karchmer AW, et al. Prophylaxis against wound infection following herniorrhaphy or breast surgery. [Prophylaxis against wound infection following herniorrhaphy or breast surgery.]. J Infect Dis 1993;166(3):556‐60.

Reggiori 1996 {published data only}

Reggiori A, Ravera M, Cocozza E, Andreata M, Mukasa F. Randomized study of antibiotic prophylaxis for general and gynaecological surgery from a single centre in rural Africa. Br J Surg 1996;83:356‐9.

Ryan 1967 {published data only}

Ryan EA. Wound infection prevention by topical antibiotics. Br J Surg 1967;54(5):324‐9.

Shwed 1991 {published data only}

Shwed JA, Danziger LH, Wojtynek J, Rodwold KA. A comparative evaluation of the safety and efficacy of cefotetan and cefoxitin in surgical prophylaxis.. DICP 1991;25:10‐3.

Spallitta 1999 {published data only}

Spallitta SI, Temrine G, Zappulla A, Greco V, compagno GM, Lo‐lacono I, et al. Tension‐free hernioplasty in the treatment of inguinal hernia in the adult: our experience with local anesthesia and a review of the literature [Ernioplastica "tension‐free" nel trattamento dell'ernia inguinale dell'adulto: la nostra esperienza in anestesia locale e revisione della letteratura]. Minerva Chir 1999;54(9):573‐89.

Sultan 1989 {published data only}

Sultan S, Ahmed R, Mufti T, Mohammad G, Nawaz M. Use of prophylactic antibiotic in clean surgical cases. A prospective trial of various regimens.. J Pak Med Assoc 1989;39(1):9‐12.

Van‐Damme 1981 {published data only}

Van‐Damme JP, Timmermans TT. Wound infections in general surgery. A two‐year prospective study in a private hospital. Acta Chir Belg 1981;80(4):161‐9.

Vara 1993 {published data only}

Vara R, Ruiz M, Rosell J, Tovar JL, Moreno A, Guerrero JA, et al. Chemoprophylaxis in inguinal herniorrhaphy? [¿Quimioprofilaxis en cirugía herniaria?]. Cir Esp 1993;53(3):105‐7.

Wantz 1996 {published data only}

Wantz GE. Experience with tension‐free hernioplasty for primary inguinal hernia in men. J Am Coll Surg 1996;183(4):351‐6.

Wersink 1991 {published data only}

Weersink A, Visser M, Vos A, Hulstaert P, ten‐Berge I, Muijsken M, et al. Amoxicillin‐clavulanate prophylaxis against wound infections after clean‐contaminated surgery. A controlled, randomized, prospective study. Eur J Surg 1991;157(4):271‐5.

Bailey 1992

Bailey IS, Karran SE, Toyn K, Brough P, Ranaboldo C, Karran SJ. Community surveillance of complications after hernia surgery. BMJ 1992;304(6825):469‐71.

Cainzos 1990

Cainzos M, Lozano F, Balibrea JL, Dávila D, Potel J, Gómez Alonso A, et al. Postoperative infection: multicentric, prospective and controlled study. [La infección postoperatoria: estudio multicéntrico, prospectivo y controlado.]. Cir Esp 1990;48(5):481‐90.

Codina 1999

Codina C, Trilla A, Riera N, Tuset M, Carne X, Ribas J, et al. Perioperative antibiotic prophylaxis in Spanish hospitals: results of a questionnaire survey. Infect Control Hosp Epidemiol 1999;20(6):436‐9.

Condon 1991

Condon RE, Wittmann DH. The use of antibiotics in general surgery. Curr Probl Surg 1991;28(12):803‐907.

Davey 1998

Davey PG, Nathwani D. What is the value of preventing postoperative infections?. New Horiz 1998;6(2 Suppl):S64‐71.

Deeks 1999

Deeks J, Bradburn M, Localio R, Berlin J. [Much Ado About Nothing: Statistical Methods for Meta‐analysis with Rare Events.]. Presentatioon held at the 2nd Symposium on Systematic Reviews: Beyond the basics.. St. Ctatherine's College, Oxford. UK, 1999.

Dellinger 1994

Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Clin infect Dis 1994;18:422‐7.

DerSimonian 1982

DerSimonian R, Charette J, McPeek B, Mosteller F. Reporting on methods in clinical trials. N Engl J Med 1982;306:1332‐7.

Haley 1985

Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton TM. Identifying patients at high risk of surgical wound infection. Am J Epidemiol 1985;121:206‐215.

Heineck 1999

Heineck I, Ferreira MB, Schenkel EP. Prescribing practice for antibiotic prophylaxis for 3 commonly performed surgeries in a teaching hospital in Brazil. Am J Infect Control 1999;27(3):296‐300.

Holmes 1994

Holmes J, Readman R. A study of wound infections following inguinal hernia repair. J Hosp Infect 1994;28:153‐6.

Horan 1992

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13(10):606‐8.

Imperiale 1999

Imperiale TE. Meta‐analysis: When and how. Hepatology 1999;29(Suppl 1):26S‐31S.

Leaper 1998

Leaper DJ. Use of antibiotic prophylaxis in clean non‐implant wounds. J Antimicrob Chemother 1998;41:501‐4.

Mangram 1999

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, The Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20(4):247‐78.

Mozillo 1988

Mozillo N, Greco D, Pescini A, Formato A. Chemoprophylaxis in the surgical ward: results of a national survey in Italy. Eur J Epidemiol 1988;4(3):357‐9.

NRC 1964

National Academy of Sciences, National Research Council, Division of Medical Sciences, Ad Hoc Commitee on Trauma. Postoperative wound infections: the influence of ultraviolet irradiation on the operating room and of various other factors.. Ann Surg 1964;16(Suppl 2):1‐196.

Page 1993

Page CP, Bohnen JMA, Fletcher JR, MacManus AT, Solomkin JS, Wittmann DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg 1993;128:79‐88.

Porcu 1996

Porcu A, Noya G, Dessanti A, Niolu P, Cottu P, Castiglia P, Dettori G. A new approach to the problem of surgical wound infections in clean operations. Minerva Chir 1996;51(9):691‐6.

Ranaboldo 1993

Ranaboldo CJ, Karran SE, Bailey S, Karran SJ. Antimicrobial prophylaxis in clean surgery: hernia repair. J Antimicrob Chemother 1993;31(Suppl B):35‐41.

Rutkow 1993

Rutkow IM, Robbins AW. Tension‐free inguinal herniorrhaphy: a preliminary report on the mesh‐plug technique. Surgery 1993;114:3‐8.

Sackett 1997

Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence‐based Medicine. How to Practice & Teach EBM. Edinburgh: Churchill Livingstone, 1997.

Sacks 1987

Sacks HS, Berrier J, Reitman D, Ancona‐Berk VA, Chalmers ThC. Meta‐analyses of randomized controlled trials. N Engl J Med 1987;316(8):450‐5.

Sanderson 1999

Sanderson PJ. Assessing the role of prophylactic antibiotics in clean surgery. J Hosp Infect 1999;42:7‐9.

Wittmann 1995

Wittmann DH, Schein M, Condon RE. Antibiotic prophylaxis in abdominal wall hernia surgery: never, always, or selectively?. Probl Gen Surg 1995;12(1):47‐55.

Woods 1998

Woods RK, Dellinger EP. Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physysician 1998;58(11):2731‐40.

References to other published versions of this review

Ir a:

Sanchez‐Manuel 2001

Sánchez‐Manuel FJ, Seco‐Gil JL, Lozano‐García J. [Antibiotic prophylaxis and hernia repair. Systematic quantitative review results]. [Spanish] [Profilaxis antibiótica y reparación herniaria. Resultado de una revisión sistemática cuantitativa.]. Enferm Infecc Microbiol Clin 2001;19(3):107‐13.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Andersen 1980

Methods

Study: prospective, randomized
Allocation: NM
Blinding: yes.

Participants

287 patients:
137 P / 150 C

Interventions

ATB= ampicillin 1 g subfascial
MA= before closure fascial
Control= no treatment

Outcomes

IP= 5
IC= 6

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

Unclear risk

B ‐ Unclear
Andersen 1980

Methods

Participants

Interventions

Outcomes

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

Unclear risk

D ‐ Not used
Evans 1973

Methods

Study: prospective, randomized.
Allocation: coin.
Blinding: no.

Participants

97 patients:
48 P / 49 C

Interventions

ATB= cefaloridine 1 g IM
MA= induction and two dosis postoperatives.
Control= no treatment

Outcomes

IP= 1
IC= 2

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

High risk

C ‐ Inadequate
Lazorthes 1992

Methods

Study: prospective, randomized.
Allocation: NM
Blinding: no.

Participants

308 patients:
155 P / 153 C

Interventions

ATB= cefamandol 750 mg subcutaneous.
MA= added to local anesthesia.
Control= no treatment

Outcomes

IP= 0
IC= 7

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

Unclear risk

B ‐ Unclear
Morales 2000

Methods

Study: multicenter, prospective, randomized.
Allocation: envelopes
Blinded: yes.

Participants

524 patients:
237 P / 287 C

Interventions

ATB= cefazolin 2 g IV.
MA= induction.
Control= placebo

Outcomes

IP= 4
IC= 6

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

Low risk

A ‐ Adequate
Oteiza 2004

Methods

Study:
prospective, randomized.
Allocation: computer.
Blinding: no.

Participants

247 patients:
124 P / 123 C

Interventions

ATB= amoxicillin‐clavulanic 2 g IV
MA= 15‐30 minutes before the incision.
Control: no treatment.

Outcomes

IP= 1
IC= 0

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

Low risk

A ‐ Adequate
Platt 1990

Methods

Study: multicenter, prospective, randomized.
Allocation: computer.
Blinding: yes.

Participants

612 patients:
301 P / 311 C

Interventions

ATB= cefonicid 1 g IV
MA= before 90 minutes off the surgery.
Control= placebo

Outcomes

IP= 4
IC= 6

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

Low risk

A ‐ Adequate
Taylor 1997

Methods

Study: multicenter, prospective, randomized.
Allocation: computer.
Blinding: yes.

Participants

269 patients:136 P / 133 C

Interventions

ATB= Amoxicillin‐clavulanic 1,2 g IV.
MA= before the incision.
Control= placebo.

Outcomes

IP= 1IC= 12

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

Low risk

A ‐ Adequate
Yerdel 2001

Methods

Study: prospective, randomized.
Allocation: computer.
Blinding: yes.

Participants

269 patients:
136 P / 133 C

Interventions

ATB= Ampicilln‐sulbactam 1,5 g IV.
MA= before the incision.
Control= placebo.

Outcomes

IP= 1
IC= 12

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

Low risk

A ‐ Adequate

P = prophylaxis group, C = control group, IP = infected with prophylaxis, IC = infected without prophylaxis, NM = not mencioned, ATB = antibiotic, MA = timing of prophylaxis administration

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Abo‐Rahmy 1998

NOT RANDOMIZED. A total of 1524 consecutive hernia patients, dividided in 3 groups: A) 606 with ceftriaxone, B) 408 with pefloxacine, C) 510 with several cefalosporins or quinolons differents to the A and B groups. One single patient with infection was observed (0,06%).

Angio 2001

UNCONTROLLED TRIAL. Single arm with antibiotic prophylaxis. 112 patients submitted to prosthetic herniplasty by anterior approach (94 cases) and by transabdominal preperitoneal laparoscopy (18 cases), received levofloxacin 500 mg IV 30 minutes before the surgical operation and 500 mg os in seven days following. Infection rate was zero.

Barreca 2000

RETROSPECTIVE. Study developed in two hospitals, one arm by hospital. Administers cefotaxime 2 gr IV 30' before surgery. A total of 147 patients, 63 with prophylaxis and 84 without; 87% with hernioplasty . Both hospitals show an infection rate of zero.

Bozzetti 1975

DOES NOT INCLUDE HERNIA PATHOLOGY.

Dazzi 1994

UNCONTROLLED TRIAL. Single arm with antibiotic prophylaxis. Patients with several pathologies; can be identified 189 hernia patients (100 herniorraphy, 89 hernioplasty), prophylaxis with teicoplanine. Infection rate: zero.

Escartín 1999

RETROSPECTIVE. Study with 475 patients. In 277 prosthetic material is used: 144 with antibiotic prophylaxis (3 infected) and 133 with placebo (10 infected). In 198 patients no prosthetic material was used: 14 with antibiotic prophylaxis (0 infected) and 184 with placebo (13 infected). They recommend prophylaxis when using prosthetic material.

Gaskill 1989

DOES NOT INCLUDE HERNIA PATHOLOGY.

Gervino 2000

UNCONTROLLED TRIAL. Single arm with antibiotic prophylaxis. 1254 patients intervened with prosthetic material, received ceftriaxone IV 2 g before surgery. Infection rate assessed retrospectively: zero .

Gilbert 1993

RETROSPECTIVE. Large serie that presents methodologic handicaps. Infection rate: a)primary herniorraphy: 1.1% without prophylaxis and 1.3% with prophylaxis; b) primary hernioplasty: 0.34% without prophylaxis and 0.98% with prophylaxis; c) herniorraphy for recurrent hernia: 0% in both groups; d) hernioplasty for recurrent hernia: 2.2% without prophylaxis and 0.43% with prophylaxis. They do not recommend antibiotic prophylaxis on surgery for hernia repair.

Gilmore 1977

PROPHYLAXIS WITH ANTISEPTIC TREATMENT.

Hair 2000

RETROSPECTIVE. Multicentric trial where 71% of 5.506 patients received antibiotic prophylaxis. Global infection rate: 8%, without significative differences between patients with and without antibiotic prophylaxis (RR 0.9, IC95% 0.7 ‐ 1.1). Individualized infection rate is not provided for each group. They recommend not to administer antibiotic prophylaxis.

Hedawoo 1995

REVIEW. In a study of clean surgical techniques, 134 hydroceles and hernias are included, without antibiotic prophylaxis. Infection rate 3,6%.

Houck 1989

INCOMPLETE DATA. The objective of the study is prophylaxis in incisional hernia and patients with inguinal hernia constitute the control group. Data for these patients is not provided.

Karran 1992

INCOMPLETE STUDY. No results provided.

Lewis 1995

INCOMPLETE DATA. Prospective, randomized, well‐designed study on clean surgical techniques. A total of 165 patients had hernia repair (86 receiving cefotaxime 2 gr IV prior to surgery and 79 receiving placebo), but there's no information on the number of infections on these patients. INCOMPLETE DATA. Prospective, randomized, well‐designed study on clean surgical techniques. A total of 165 patients had hernia repair (86 receiving cefotaxime 2 gr IV prior to surgery and 79 receiving placebo), but there's no information on the number of infections on these patients.

Lord 1977

DOES NOT INCLUDE HERNIA PATHOLOGY.

Lord 1983

DOES NOT INCLUDE HERNIA PATHOLOGY.

Luke 1991

DOES NOT INCLUDE HERNIA PATHOLOGY.

Massaioli 1995

UNCONTROLLED TRIAL. Single arm of antibiotic prophylaxis with vancomicine on patients with incisional hernia or inguinal hernia repair with prosthesic material. Infection rate: 1/40 patients (2,5%).

Menzies 1989

DOES NOT INCLUDE HERNIA PATHOLOGY.

Musella 2001

BOTH STUDY ARMS RECEIVED PROPHYLAXIS. Both groups received prophylaxis with a systemic antibiotic. Intervention group, additionally, is administered a colagen sponge impregned with gentamicine. Infection rate: 6/284 patients on control group and 1/293 patients on prophylaxis group
(OR=0.16; IC95% 0.02‐1.33).

Nundy 1983

INCOMPLETE DATA. Study on clean surgical techniques, not possible to obtain data of patients with hernia repair. Prophylaxis is penicilline 2 to 12 hours prior to the surgery.

Platt 1992

NOT RANDOMISED. Study developed with the patients not included on the published 1990 trial. A total of 1221 patients with herniorraphy. Infection rate: 2/239 patients on prophylaxis, and 15/982 patients without prophylaxis (OR 0.54; IC95% 0,06‐2,07; p= 0.4). They recomment prophylaxis only for high risk patients.

Reggiori 1996

BOTH STUDY ARMS RECEIVED PROPHYLAXIS. Prospective randomised trial, well designed, administering a single dose of ampiciline 2 g IV at induction of anaesthesia in one arm and fortified procaine 1,2 megaunits/24 h IM daily for seven days starting about 3 h after surgery on the other arm. Infection rate: 0/123 patients on ampiciline and 8/106 patients on peniciline (OR = 0,05; IC 95% 0,0 ‐ 0,82).

Ryan 1967

NOT RANDOMISED. Non homogeneous groups: control group with majority of patients on local anaesthesia, prophylaxis group with majority of patients on general anaesthesia. Children are included on the trial. Control group is sequential in time to the intervention group. Each group is intervened in a different hospital. Infection rate: 82/5335 patients in control grop, 2/1183 patients in peniciline gropu. (OR 0.11; IC95% 0.03‐0.44)

Shwed 1991

BOTH STUDY ARMS RECEIVED PROPHYLAXIS. Study of several surgical techniques to evaluate the efficacy of a new antibiotic in front of an already stablished one. A total of 128 patients, 5 of whom had hernia repair.

Spallitta 1999

UNCONTROLLED TRIAL. Single arm of 100 patients receiving antibiotic prophylaxis and prosthetic material.

Sultan 1989

BOTH STUDY ARMS RECEIVED PROPHYLAXIS.

Van‐Damme 1981

NOT RANDOMISED. Technical review using different types of antibiotics, both intravenous and topical.

Vara 1993

MISBALANCES IN TREATMENT BETWEEN GROUPS: Patients with hernioplasty received prophylaxis while patients with herniorraphy received placebo . Patients infected: 2/141 patients on prophylaxis and 9 /137 patients on placebo. They recommend antibiotic prophylaxis to all patients.

Wantz 1996

RETROSPECTIVE SERIE. Serie of 1076 patients followed for 6 years. Administers local anaesthesia and prosthetic material (Lichtentein and Gilbert), without antibiotic prophylaxis. One single patient with infection (0,09%).

Wersink 1991

DOES NOT INCLUDE HERNIA PATHOLOGY.

Data and analyses

Open in table viewer
Comparison 1. Antibiotic prophylaxis vs Placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Wound infection Show forest plot

8

2907

Odds Ratio (M‐H, Random, 95% CI)

0.65 [0.35, 1.21]
Analysis 1.1
Comparison 1 Antibiotic prophylaxis vs Placebo, Outcome 1 Wound infection.

Comparison 1 Antibiotic prophylaxis vs Placebo, Outcome 1 Wound infection.

1.1 Herniorraphies

5

1867

Odds Ratio (M‐H, Random, 95% CI)

0.84 [0.53, 1.34]

1.2 Hernioplasties

3

1040

Odds Ratio (M‐H, Random, 95% CI)

0.48 [0.07, 3.37]

Comparison 1 Antibiotic prophylaxis vs Placebo, Outcome 1 Wound infection.
Figuras y tablas -
Analysis 1.1

Comparison 1 Antibiotic prophylaxis vs Placebo, Outcome 1 Wound infection.

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Table 1. Data form

Parameter

Score

ANDERSEN

EVANS

LAZORTHES

PLATT

TAYLOR

MORALES

YERDEL

OTEIZA

(A) Random allocation

1 = explained 0 = not explained

0

1

0

1

1

1

1

1

(B) Blinded study

1 = yes 0 = no

1

0

0

1

1

1

1

0

(C) Groups of patients are homogeneous

1 = comparable in technique used, age, sex and comorbid factors 0,5 = one factor differs significantly 0 = more than one factor differs significantly or comparability not specified

0.5

0

1

1

1

1

1

1

(D) Statistical method adequate

1 = yes 0 = no

1

0

0

1

1

1

1

1

(E) Incisional surgical site infection was definied

1 = yes 0 = no

1

1

0

1

1

1

1

1

(F) Number of antibiotics

1 = uses only one antibiotic 0,5 = uses more than one antibiotic

1

1

1

1

1

1

1

1

(G) Outcome assesment

1 = by personel no related to study 0,5 = by study personel 0 = not specified

0

0.5

0.5

0.5

1

0.5

1

0.5

(H) Route of administration

1 = especified 0 = not especified

1

1

1

1

1

1

1

1

(I) Number of doses

1 = especified 0= not especified

1

1

1

1

1

1

1

1

(J) Timing of administration

1 = especified 0 = not especified

1

1

1

1

1

1

1

1

SCORE (%)

7,5 (75%)

6,5 (65%)

5,5 (55%)

9,5 (95%)

10 (100%)

9,5 (95%)

10 (100%)

8,5 (85%)
Figuras y tablas -
Table 1. Data form
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Table 2. Comparative and controlled studies

AUTHOR/YEAR

PROPHYLAXIS n/N (%)

CONTROL n/N (%)

OR (95% CI Random)

Andersen 1980

5/137 (3,6%)

6/150 (4%)

0.91 (0.27,3.05)

Escartín 1999

0/14 (0%)

13/184 (7%)

0.44 (0.02,7.75)

Evans 1973

1/48 (2%)

2/49 (4%)

0.50 (0.04,5.70)

Lazorthes 1992

0/155 (0%)

7/153 (4,5%)

0.06 (0.00,1.11)

Platt 1990

4/301 (1,3%)

6/311 (1,9%)

0.68 (0.19,2.45)

Platt 1992

2/239 (0,8%)

15/982 (1,5%)

0.54 (0.12,2.40)

Reggiori 1996

0/123 (0%)

8/106 (7,5%)

0.05 (0.00,0.82)

Ryan 1967

2/1183 (0,1%)

82/5335 (1,5%)

0.11(0.03,0.44)

Taylor 1997

25/283 (8,8%)

25/280 (8,9%)

0.99 (0.55,1.77)

SUBTOTAL HERNIORRAPHIES (heterogeneity chi‐square=16.93 df=8 p=0.031)

39/2483 (1,5%)

164/7550 (2,1%)

0.34 (0.20,0.91)

Barreca 2000

0/63 (0%)

0/84 (0%)

Not Estimable

Escartín 1999

3/144 (2%)

10/133 (7,5%)

0.26 (0.07,0.97)

Gilbert 1993

10/1150 (0,8%)

4/684 (0,6%)

1.49 (0.47,4.77)

Morales 2000

4/237 (1,6%)

6/287 (2,1%)

0.80 (0.22,2.88)

Musella 2001

1/293 (0,3%)

6/284 (2,1%)

0.16(0.02,1.33)

Vara 1993

2/141 (1,4%)

9/137 (6,5%)

0.20 (0.04,0.97)

Yerdel 2001

1/136 (0,7%)

12/133 (9%)

0.07 (0.01,0.58)

Otaiza 2004

1/124 (0,8%)

0/123 (0%)

Not Estimable

SUBTOTAL HERNIOPLASTIES (heterogeneity chi‐square=10.61 df=5 p=0.06)

22/2288 (0,9%)

47/1865 (2,5%)

0.37 (0.15,0.90)

T O T A L (heterogeneity chi‐square=28.21 df=14 p=0.013)

61/4771 (1,3%)

211/9415 (2,2%)

0.41 (0.24,0.71)
Figuras y tablas -
Table 2. Comparative and controlled studies
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Comparison 1. Antibiotic prophylaxis vs Placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Wound infection Show forest plot

8

2907

Odds Ratio (M‐H, Random, 95% CI)

0.65 [0.35, 1.21]

1.1 Herniorraphies

5

1867

Odds Ratio (M‐H, Random, 95% CI)

0.84 [0.53, 1.34]

1.2 Hernioplasties

3

1040

Odds Ratio (M‐H, Random, 95% CI)

0.48 [0.07, 3.37]
Figuras y tablas -
Comparison 1. Antibiotic prophylaxis vs Placebo
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