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Link to original content: http://pubmed.ncbi.nlm.nih.gov/38722398/
Topical antimicrobial treatment of mesh for the reduction of surgical site infections after hernia repair: a systematic review and meta-analysis - PubMed Skip to main page content
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Review
. 2024 Jun;28(3):691-700.
doi: 10.1007/s10029-024-02987-0. Epub 2024 May 9.

Topical antimicrobial treatment of mesh for the reduction of surgical site infections after hernia repair: a systematic review and meta-analysis

Nathan Bontekoning  1   2 , Nathalie J Huizing  1 , Allard S Timmer  1   2 , Hannah Groenen  1   2 , Stijn W de Jonge  1   2 , Marja A Boermeester  3   4
Affiliations
Review

Topical antimicrobial treatment of mesh for the reduction of surgical site infections after hernia repair: a systematic review and meta-analysis

Nathan Bontekoning et al. Hernia. 2024 Jun.

Abstract

Purpose: Use of mesh is essential in hernia repair. A common complication after hernia repair is surgical site infection (SSI), which poses a risk in spreading to the mesh, possibly causing mesh infection. Topical antimicrobial pretreatment of mesh may potentially reduce SSI risk in hernia repair and has shown promising results in in vitro and in vivo studies. Clinical evidence, however, is more important. This systematic review aims to provide an overview of available clinical evidence for antimicrobial pretreated mesh in hernia repair surgery to reduce SSI.

Methods: We report in accordance with PRISMA guidelines. CENTRAL, EMBASE, CINAHL and PubMed were searched up to October 2023 for studies that investigated the use of antimicrobial pretreated mesh on SSI incidence in adults undergoing hernia repair. The primary outcome was SSI incidence. We also collected data on pathogen involvement, hernia recurrence, and mesh infection. A meta-analysis on SSI risk and GRADE-assessment was performed of eligible studies.

Results: We identified 11 eligible studies (n = 2660 patients); 5 randomized trials and 6 cohort studies. Investigated interventions included pre-coated mesh, antibiotic carriers, mesh soaked or irrigated with antibiotic or antiseptic solution. Meta-analysis showed no significant reduction in SSI for antibiotic pretreated polypropylene mesh (RR 0.76 [95% CI 0.27; 2.09]; I2 50%).

Conclusion: Data on topical mesh pretreatment to reduce SSI risk after hernia repair is limited. Very low certainty evidence from randomized trials in hernia repair surgery shows no significant benefit for antibiotic mesh pretreatment for SSI reduction, but data are imprecise due to optimal information size not being met.

Keywords: Antibiotics; Antimicriobials; Mesh; Pretreatment; Surgical site infection; Topical.

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Conflict of interest statement

Author MAB reported receiving institutional grants from J&J/Ethicon and 3M; and being a speaker and/or instructor for J&J/Ethicon, 3M, BD, Gore, Smith & Nephew, TelaBio, Angiodynamics, GDM, Medtronic, Molnlycke. All other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA systematic review flow diagram
Fig. 2
Fig. 2
Forest plot of SSI rate in RCTs in which antibiotic mesh treatment is compared with no antibiotic mesh treatment. RCTs with systemic antibiotic prophylaxis administered in both arms are pooled in meta-analysis. Observational studies are not pooled
See this image and copyright information in PMC

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