Antibiotikaprofylax vid kirurgiska ingrepp - SBU

Table 4.1.12 Hernia repair.
Author
Year
Reference
Country
Study
design
Population
characteristics
Intervention
Method
Number individuals
Control
Number
individuals
Results
Withdrawal
Drop outs
Study quality
and relevance
Comments
Abramov
1996
[60]
Israel
RCT
To evaluate wound
infection in umbilical
and incisional hernia.
Mesh-technique post-op.
n=41
Follow-up 3 weeks
I: Cefonicid 1 g iv 30 min
before operation
C: Placebo SSI
I: 1/17 (6%)
C: 8/18 (44%)
OR 0.08 (95%
CI 0.08–0.72)
7 protocol
violation
Moderate
Too few pts. Only study
available. Ab can be recommended
Aufenacker
2004
[70]
The Netherlands
RCT
Multicenter
Ab prophylaxis in elective
hernia prosthetic repair.
Double blind. Computerbased
randomisation.
Standardised supervised
operation. Defined SSI.
Power calculation.
1 040 pts allocated
to compensate for
drop outs.
n=978
Follow-up 12 weeks
I: Cefuroxime 1 500 mg iv
at induction of anesthesia
(n=503)
C: Placebo
(n=505)
SSI
I: 8/503 (1.6%)
C: 9/505 (1.8%)
NNT 520 pts
25 no
consent,
not operated.
19 protocol
violation
High
No benefit. Risk factors
for infection: female,
>60 years, bilateral hernia.
Low infection rate. Problem:
optimal timing of administration
of ab. In metaanalysis
[3,57]
Aufenacker
2006
[3]
The Netherlands
Metaanalysis
To determine whether
systemic antibiotic prophylaxis
prevented wound
infection after repair of
abdominal wall hernia
with mesh, 1966–2005.
8 out of 26 potentially
relevant studies.
n=2 507
Ab cefonicid 1 g,
cefuroxime 1.5 g,
cefazolin 2 g,
ampicillin +
sulbactan 1.5 g,
ampicillin + clavulanic
acid 2 g (n=1 230)
C: Placebo
(n=1 277)
Superficial infection
I: 18/1 230 (1.5%)
C: 38/1 277 (3.0%)
OR 0.54, NNT 74
Deep infection
I: 0.3%
C: 0.6%
OR 0.50, NNT 401
High
One study only with umbilical
and incisional repair.
No difference between
groups, but study only
moderate quality. Antibiotic
prophylaxis did not prevent
the occurrence of wound
infection after groin hernia
surgery and should not be
used. Exception in pts with
high risk eg long operations
>60 min and depressed
immune function
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