This is not the most recent version of the article. View current version (15 FEB 2012)
Intervention Review
Antibiotic prophylaxis for hernia repair.
Editorial Group: Cochrane Colorectal Cancer Group
Published Online: 7 OCT 2009
Assessed as up-to-date: 28 JUN 2009
DOI: 10.1002/14651858.CD003769.pub3
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
How to Cite
Sanchez-Manuel FJ, Lozano-García J, Seco-Gil JL. Antibiotic prophylaxis for hernia repair.. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003769. DOI: 10.1002/14651858.CD003769.pub3.
Publication History
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 7 OCT 2009
This is not the most recent version of the article.View current version (15 Feb 2012)
Abstract
Background
The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area.
Objectives
The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair.
Search methods
In the present review, we searched for eligible trials in June 2009, using the search terms below. This revealed one new included trial (total of thirteen).
We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline and Embase was conducted using the following terms: #1 antibiotic* or antimicrob* or anti infecti* or antiinfecti*; #2 prophyla* or prevent*; #3 #1 and #2; #4 clean and (surgery or tech* or proced*); #5 herni*; #6 (wound infection) and #4; #7 #3 and (#4 or #5 or #6). Reference lists of the included studies were checked to identify additional studies.
Selection criteria
Only randomized clinical trials were included.
Data collection and analysis
Thirteen randomized clinical trials were identified. Seven of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorraphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A random effects model was used in the analysis.
Main results
The total number of patients included was 6825 (prophylaxis group: 4188, control group: 2637). Overall infection rates were 2.8% and 3.9% in the prophylaxis and control groups, respectively (OR 0.64, 95%CI 0.48 - 0.85).
The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 - 1.00).
The subgroup of patients with hernioplasty had infection rates of 1.4% and 2.9% in the prophylaxis and control groups, respectively (OR 0.49, 95% CI 0.29 - 0.86).
Authors' conclusions
Based on the results of this systematic review the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Neither can the administration be recommended against when high rates of wound infection are observed.
Plain language summary
Administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended.
The use of antibiotic prophylaxis for elective hernia repair is currently a controversial issue. Although elective hernia repair is considered a clean procedure, the rate of postoperative wound infection in many countries exceeds the one expected for clean surgery, increasing discomfort in patients and health care expenses. In addition, antibiotics administration is not exempt of potential risks.
Controlled clinical trials on the use of antibiotic prophylaxis for hernia repair are scarce, the number of patients studied is low and the results are diverse. Based on the results of this meta-analysis of randomized clinical trials, administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Neither can the administration be recommended when high rates of wound infection are observed.
摘要
背景
預防性抗生素用於疝氣修補
由於本領域各研究結果對於使用預防性抗生素幫助疝氣修補目前有所出入，因此該作法具有爭議。
目標
本文獻回顧的目標在於確認預防性抗生素對於降低腹股溝疝氣修補術後傷口感染率的效果。
搜尋策略
在本回顧當中，我們於2006年8月使用下列的關鍵字檢索合適的試驗，總計有4篇相關的研究被納入(總共篩選出12個研究)。 我們也檢索了Cochrane Colorectal Cancer Group，檢索策略為利用自由格式或是MeSH關鍵字交叉檢索「herni* 和inguinal 或groin」和「antimicr*或 antibiot*」等關鍵字。並以相似的檢索策略搜尋Medline和Embase資料庫，同時也會搭配下列各組關鍵字：第1組「antibiotic*或antimicrob*或anti infecti*或antiinfecti*」，第2組「prophyla* 或 prevent*」， 第3組「 #1組和#2組」，第4組「clean和(surgery或tech*或proced*)」，第5組「 herni*」、第6組「 (wound infection)和 #4組」; 第7組「第3組和 (第4組或 第5組或第6組)」，納入研究的試驗的參考文獻清單也會被用來確認是否有其他應該納入研究的試驗。
選擇標準
本研究只納入隨機臨床試驗。
資料收集與分析
總計有12個隨機性臨床試驗被納入本研究中，其中有6個試驗是利用人工材料(hernioplasty，疝氣造形術)來治療疝氣，而其他試驗則不是這樣進行(herniorraphy，疝氣縫合術)。並以是否有使用人工材料來決定是否要匯總結果及進行次群體分析(subgroup analysis)。並於分析當中使用隨機效果模式。
主要結論
被納入試驗的患者共計6705人(治療組4128人、對照組2577人)。使用預防性抗生素的組別和對照組中整體感染率分別為2.9％和3.9％(OR值為0.64，95％的信賴區間介於0.48至0.85之間)。使用預防性抗生素的組別和對照組中，進行疝氣縫合術的次群體其感染率分別為3.5％和4.9％(OR值為0.71，95％的信賴區間介於0.51至1.00之間)。進行疝氣造形術的次群體其感染率分別為1.4％和2.9％(OR值為0.48，95％的信賴區間介於0.27至0.85之間)。
作者結論
根據統合分析(metaanalysis)的結果，目前並不會普遍建議選擇性腹股溝疝氣修補手術患者使用預防性抗生素；而在傷口感染率很高時，也不會建議患者進行這樣的處置。
翻譯人
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
預防性抗生素用於疝氣修補
總結
使用預防性抗生素來協助選擇性疝氣修補手術是近來一個具有爭議的議題，雖然選擇性疝氣修補手術被認為是一個潔淨度高的措施，但是某些國家的術後傷口感染率仍遠超過一般對於潔淨手術的預期，也因而造成患者的不適感及醫療費用。此外，使用抗生素並不能完全免除潛在的風險，目前有許多對於使用預防性抗生素於疝氣修補手術的對照性臨床試驗，基於隨機臨床試驗進行的統合分析結果顯示並不能普遍建議患者進行這樣的治療，而且就算傷口感染率很高的情況下，也不能建議患者使用預防性抗生素。