Comparison of Topical Antibiotics Plus Intravenous Antibiotics Versus Intravenous Antibiotics Alone in Prevention of Surgical Site Infection in Inguinal Hernia Repair Topical vs. Intravenous Antibiotics in Preventing SSIs in Hernia Repair
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Abstract
Background: Surgical site infections (SSIs) are a common complication following inguinal hernia repair, contributing to increased morbidity and healthcare costs. The role of combined topical and intravenous (IV) antibiotics in reducing SSIs remains debated.
Objective: To compare the efficacy of topical plus IV antibiotics versus IV antibiotics alone in preventing SSIs in inguinal hernia repair.
Methods: This randomized controlled trial included 400 male patients aged 20-70 years undergoing elective inguinal hernia repair under spinal anesthesia at Lahore General Hospital. Patients were randomly assigned to receive either IV cefazolin alone (Group B, n=200) or a combination of IV cefazolin and topical gentamicin (Group A, n=200). Patients were followed for 30 days postoperatively for SSIs. Data were analyzed using SPSS version 25.0, with significance set at p≤0.05.
Results: SSIs were significantly lower in Group A (2.5%, n=5) compared to Group B (9.5%, n=19) (p=0.003). The reduction was notable in patients aged >50 years (p=0.040), with BMI >25 kg/m² (p=0.010), smokers (p=0.026), and those with operative times >45 minutes (p=0.035).
Conclusion: The combination of topical and IV antibiotics significantly reduces SSIs in inguinal hernia repair, particularly in high-risk patients.
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References
Norman G, Shi C, Goh EL, Murphy EM, Reid A, Chiverton L, et al. Negative Pressure Wound Therapy For Surgical Wounds Healing By Primary Closure. Cochrane Database Syst Rev. 2022;4(4). doi:10.1002/14651858.CD009261.pub7.
López-Cano M, Kraft M, Curell A, Puig-Asensio M, Balibrea J, Armengol-Carrasco M, et al. Use Of Topical Antibiotics Before Primary Incision Closure To Prevent Surgical Site Infection: A Meta-Analysis. Surg Infect. 2019;20(4):261-70.
Gillespie BM, Harbeck E, Rattray M, Liang R, Walker R, Latimer S, et al. Worldwide Incidence Of Surgical Site Infections In General Surgical Patients: A Systematic Review And Meta-Analysis Of 488,594 Patients. Int J Surg. 2021;95:106136. doi: https://doi.org/10.1016/j.ijsu.2021.106136.
Khan FU, Fang Y, Khan Z, Khan FU, Malik ZI, Ahmed N, et al. Occurrence, Associated Risk Factors, And Treatment Of Surgical Site Infections In Pakistan. Eur J Inflamm. 2020;18:2058739220960547.
Seidelman JL, Mantyh CR, Anderson DJ. Surgical Site Infection Prevention: A Review. JAMA. 2023;329(3):244-52. doi:10.1001/jama.2022.24075.
Du Y, Han S, Zhou Y, Chen HF, Lu YL, Kong ZY, et al. Severe Wound Infection By MRCNS Following Bilateral Inguinal Herniorrhaphy. BMC Infect Dis. 2023;23(1):85.
Iftikhar J, Zehra B, Zubair R, Channa MA, Ali MA, Zehra F. Frequency Of Surgical Site Infections And Surgical Site Occurrences Requiring Procedural Intervention In Patients Undergoing Inguinal Hernia Repair. Pak J Surg. 2023;39(2):98-101.
Syed MK, Al Faqeeh AA, Othman A, Hussein AA, Rajab H, Hussain S, et al. Antimicrobial Prophylaxis In Clean Pediatric Surgical Procedures: A Necessity Or Redundancy? Cureus. 2020;12(9).
Yadav S, Kchhawa DS, Meena J. Effect Of Antibiotic Prophylaxis In Open Inguinal Hernioplasty (Lichtenstein Hernia Repair): A Study In Tertiary Care Center. Int Surg J. 2020;7(12):4034-8.
Weirong J, Yongjiang Y. A Meta-Analysis For Efficacy Of Prophylactic Antibiotics On Tension-Free Hernia Repair. J Surg Concept Pract. 2022;27(2):173-9.
Seker D, Seker G, Bayar B, Ergul Z, Kulacoglu H. Topical Antibiotic Prophylaxis In Lichtenstein Hernia Repair And Comparison Of Three Methods: A Prospective Randomized Clinical Trial. Int J Abdomin Wall Hernia Surg. 2021;4(2):58-63. doi:10.4103/ijawhs.ijawhs_6_21.
Troy MG, Dong QS, Dobrin PB, Hecht D. Do Topical Antibiotics Provide Improved Prophylaxis Against Bacterial Growth In The Presence Of Polypropylene Mesh? Am J Surg. 1996;171(4):391-3.
Hammoud M, Gerken J. Inguinal Hernia. Treasure Island, FL: StatPearls Publishing; 2024.
Doyle DJ, Hendrix JM, Garmon EH. American Society Of Anesthesiologists Classification. Treasure Island, FL: StatPearls Publishing; 2023.
Trrisha V, Shilpa A, Rupakala B, Lakshminarayana S. A Study On Surgical Site Infections And Associated Risk Factors In General Surgeries At A Tertiary Care Hospital: A Cross-Sectional Study. EMJ Microbiol Infect Dis. 2023;4(1):109-16.
Wilson RB, Farooque Y. Risks And Prevention Of Surgical Site Infection After Hernia Mesh Repair And The Predictive Utility Of ACS-NSQIP. J Gastrointest Surg. 2022;26(4):950-64. doi:10.1007/s11605-022-05248-6.
Bontekoning N, Huizing NJ, Timmer AS, Groenen H, de Jonge SW, Boermeester MA. Topical Antimicrobial Treatment Of Mesh For The Reduction Of Surgical Site Infections After Hernia Repair: A Systematic Review And Meta-Analysis. Hernia. 2024;28(3):691-700. doi:10.1007/s10029-024-02987-0.
Al Riyees L, Al Madani W, Firwana N, Balkhy HH, Ferwana M, Alkhudhayri A. Antibiotic Prophylaxis Against Surgical Site Infection After Open Hernia Surgery: A Systematic Review And Meta-Analysis. Eur Surg Res. 2021;62(3):121-33. doi:10.1159/000517404.
Charlorin P, Cadet PR. Preventing Surgical Site Infection After Lichtenstein Inguinal Hernioplasty: Preliminary Results About Local Versus IV Antibiotics Prophylaxis From A Low-Income Country University Hospital. Res Square. 2021:1-7.
Khongwar D, Tongper D, Topno N, Hajong R, Baruah AJ, Komut O, et al. Assessment Of Effectiveness Of Prophylactic Topical Antibiotic Visa-Vis Oral Antibiotic In The Prevention Of Surgical Site Infection In Elective Open Inguinal Hernioplasty J Dent Med Sci. 2018;17(6):33-42.