Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery

Abstract

BackgroundFirst‐generation cephalosporins (such as cefazolin) are recommended as antibiotic prophylaxis in groin hernia repair, but other broad‐spectrum antibiotics have also been prescribed in clinical practice. This was a systematic review and network meta‐analysis to compare the efficacy of different antibiotic classes for prevention of surgical‐site infection (SSI) after hernia repair.Methods RCTs were identified that compared efficacy of antibiotic prophylaxis on SSI after inguinal or femoral hernia repair from PubMed and Scopus databases up to March 2016. Data were extracted independently by two reviewers. Network meta‐analysis was applied to assess treatment efficacy. The probability of being the best antibiotic prophylaxis was estimated using surface under the cumulative ranking curve (SUCRA) analysis.ResultsFifteen RCTs (5159 patients) met the inclusion criteria. Interventions were first‐generation (7 RCTs, 1237 patients) and second‐generation (2 RCTs, 532) cephalosporins, β‐lactam/β‐lactamase inhibitors (6 RCTs, 619) and fluoroquinolones (2 RCTs, 581), with placebo as the most common comparator (14 RCTs, 2190). A network meta‐analysis showed that β‐lactam/β‐lactamase inhibitors and first‐generation cephalosporins were significantly superior to placebo, with a pooled risk ratio of 0·44 (95 per cent c.i. 0·25 to 0·75) and 0·62 (0·42 to 0·92) respectively. However, none of the antibiotic classes was significantly different from the others. SUCRA results indicated that β‐lactam/β‐lactamase inhibitors and first‐generation cephalosporins were ranked first and second respectively for best prophylaxis.Conclusionβ‐Lactam/β‐lactamase inhibitors followed by first‐generation cephalosporins ranked as the most effective SSI prophylaxis for adult patients undergoing groin hernia repair.

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“…We identified 2 SR/MAs and 1 retrospective observational study evaluating antimicrobial prophylaxis. [42][43][44] 42 A retrospective observational study of major emergency abdominal operations, including gastroduodenal operation, small bowel resection, colon resection, and exploratory laparotomy, found that antibiotics administered more than 12 hours after triage, compared with 6 or 12 hours, were associated with a greater odds of complications, reoperation, 30-day mortality, and prolonged LOS (all, p < 0.05). 43 Recent joint guidelines by the American Society of Health-System Pharmacists, Infectious Diseases Society of America, Surgical Infection Society, and Society for Healthcare Epidemiology of America provide recommendations for antibiotic regimens.…”