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Hernia


           Chapter 12                                           KQ12.b Are prophylactic antibiotics indicated in open
                                                              mesh repair in a high-risk patient in a low-risk
                                                              environment?
           Antibiotic prophylaxis                               KQ12.c Are prophylactic antibiotics indicated in open
                                                              mesh repair in any patient in a high-risk environment?
           A. Montgomery, Th. J. Aufenacker and J. Bingener     KQ12.d Are prophylactic antibiotics indicated in
                                                              laparoscopic repair in any patient in any risk environment?
           Introduction
           Prophylactic antibiotics in inguinal herniorrhaphies are
           intended to prevent infections, which is particularly

































           important when prosthetic material is used. However,  Evidence in literature
           unwarranted antibiotic use may create problems, notably  The latest Cochrane meta-analysis, encompassing 11 RCTs,
           patient allergies, C. difficile infection, bacterial resistance  was published in 2012. 600  Additional relevant and crucial
           and increased costs, amongst others. Antibiotic use is  data were abstracted from papers published in 2013 and
           widely accepted in patients with risk factors and in con-  2014. 4, 601, 602  In total, 17 RCTs involving 5709 patients
           taminated and infected conditions. However, prophylactic  were included to formulate the recommendations. Eight of
           antibiotic use should be questioned under clean conditions  the articles included in this analysis are of high or moderate
           in patients with limited risk factors for infection. Current  quality while the rest are of low or very low quality.
           evidence is presented.                               Difficulties in data interpretation stem from the fact that
                                                              inclusion criteria vary broadly across the RCTs. This
           Key questions                                      variation encompasses patient risk factors (e.g. immuno-
                                                              suppression, diabetes, heart failure), hernia characteristics
           KQ12.a Are prophylactic antibiotics indicated in open  (e.g. primary, bilateral, recurrent), and operative or post-
           mesh repair in an average-risk patient in a low-risk  operative interventions (e.g. wound infection incidence,
           environment?                                       hair shaving, drain use, seroma puncture). The current











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