title: Antibiotic prophylaxis for open mesh repair of groin hernia: systematic review and meta-analysis.
abstract: OBJECTIVE
  A meta-analysis was performed to asses whether antibiotic prophylaxis is effective in reducing the incidence of surgical site infection (SSI) after open mesh repair of groin hernia.
  
  
  METHODS
  A literature search for randomized controlled trials (RCT) evaluating the effectiveness of antibiotic prophylaxis in adult patients undergoing open mesh repair of groin hernia was performed in November 2015. Incidence of overall and deep SSI was considered as primary and secondary outcome measures, respectively. Only studies with a clear definition of SSI and a follow-up of at least 1 month were included. Effect size from each RCT was computed as odds ratio (OR) and 95 % confidence interval (CI) and then data were pooled using a random-effects model.
  
  
  RESULTS
  Sixteen RCTs with a total number of 5519 patients were included in the meta-analysis. Considering all the RCTs, antibiotic prophylaxis significantly reduced the overall incidence of SSI from 4.8 % to 3.2 % [OR 0.68, 95 % CI (0.51-0.91)]. However, after removal of two outlier studies, which were identified by evaluating the standardized residual, the result of the meta-analysis became non-significant [OR 0.76, 95 % CI (0.56-1.02)]. The incidence of deep SSI was very low (0-0.7 %) and the effect of antibiotic prophylaxis was not significant [OR 0.80, 95 % CI (0.32-1.99)].
  
  
  CONCLUSIONS
  The results of this meta-analysis do not support the routine use of antibiotic prophylaxis for the open mesh repair of groin hernia. In clinical settings with unexpectedly high rates of SSIs, the appropriateness of surgical asepsis should be carefully checked.
authors: Chirurgia Generale A, Policlinico Universitario di Monserrato-AOU di Cagliari, Via Mameli, 22, 09124, Cagliari, Italy. erdasernico@libero.it.
authors: E
authors: E
authors: Erdas
authors: Chirurgia Generale A, Policlinico Universitario di Monserrato-AOU di Cagliari, Via Mameli, 22, 09124, Cagliari, Italy.
authors: F
authors: F
authors: Medas
authors: Chirurgia Generale A, Policlinico Universitario di Monserrato-AOU di Cagliari, Via Mameli, 22, 09124, Cagliari, Italy.
authors: G
authors: G
authors: Pisano
authors: Chirurgia Generale A, Policlinico Universitario di Monserrato-AOU di Cagliari, Via Mameli, 22, 09124, Cagliari, Italy.
authors: A
authors: A
authors: Nicolosi
authors: Chirurgia Generale A, Policlinico Universitario di Monserrato-AOU di Cagliari, Via Mameli, 22, 09124, Cagliari, Italy.
authors: P G
authors: PG
authors: Calò
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D006119:Groin / Q000601:surgery; D006550:Hernia, Femoral / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D016032:Randomized Controlled Trials as Topic; D013526:Surgical Mesh / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Inguinal hernia repair; Surgical site infection