The Effectiveness of Topical Cefuroxime Powder in Preventing Surgical Site Infection after Elective Paraumbilical Hernia Repair using Polypropylene Mesh
DOI:
https://doi.org/10.70749/ijbr.v3i5.2328Keywords:
Antibiotic prophylaxis, Cefuroxime, Hernia repair, Mesh infection, Paraumbilical hernia, Surgical site infection.Abstract
Background: Paraumbilical hernia repair using polypropylene mesh is a widely accepted surgical approach due to its reduced recurrence rates compared with primary suture repair. However, surgical site infection remains a significant postoperative complication, particularly in patients with comorbidities such as diabetes, obesity, and smoking history. Topical application of cefuroxime powder has been proposed as an adjunctive preventive measure to lower infection risk. Objective: To determine the effectiveness of topical cefuroxime powder in preventing surgical site infection after elective paraumbilical hernia repair using polypropylene mesh as compared to no antibiotic use. Study Design: Randomized controlled trial. Duration and Place of Study: This study was conducted from May 2024 to October 2024 at the Department of General Surgery, Khyber Teaching Hospital, Peshawar. Methodology: A total of 386 patients aged 30–60 years undergoing elective paraumbilical hernia repair with mesh were randomized into two groups of 193 each. Group A received 750 mg topical cefuroxime powder applied over the mesh before closure, while Group B underwent standard repair without topical antibiotic. Postoperative follow-up was performed up to three months. Surgical site infection was diagnosed using Centers for Disease Control and Prevention criteria. Results: Surgical site infection occurred in 6 (3.1%) patients in Group A compared with 20 (10.4%) in Group B (p=0.004). Stratified analysis showed higher infection rates among overweight, diabetic, hypertensive, and smoking patients, with significant reduction in Group A across most subgroups. Conclusion: Topical cefuroxime powder significantly decreases surgical site infections in paraumbilical hernia repair with polypropylene mesh and offers a simple, effective preventive strategy.
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1. Moradian S, Klosowiak JL, Boctor MJ, Issa T, Park S, Dumanian GA, et al. Novel approach for umbilical hernia repair using mesh strips. Plast Reconstr Surg Glob Open. 2023;11(4):e4947. https://doi.org/10.1097/GOX.0000000000004947
2. Ullah N, Sharif G, Salman M, Khan Shinwari SM, Amin QK. Exploring early complications in paraumbilical hernia mesh repair: a rigorous six-month prospective study and in-depth analysis. Cureus. 2024;16(11):e73348.
https://doi.org/10.7759/cureus.73348
3. Cai XY, Chen K, Pan Y, Yang XY, Huang DY, Wang XF, et al. Total endoscopic sublay mesh repair for umbilical hernias. Medicine (Baltimore). 2021;100(25):e26334.
https://doi.org/10.1097/MD.0000000000026334
4. Ismaeil DA. Mesh repair of paraumblical hernia, outcome of 58 cases. Ann Med Surg (Lond). 2018;30:28-31.
https://doi.org/10.1016/j.amsu.2018.04.028
5. 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):950-964.
https://doi.org/10.1007/s11605-022-05248-6
6. Baylón K, Rodríguez-Camarillo P, Elías-Zúñiga A, Díaz-Elizondo JA, Gilkerson R, Lozano K, et al. Past, present and future of surgical meshes: a review. Membranes (Basel). 2017;7(3):47.
https://doi.org/10.3390/membranes7030047
7. Keric N, Campbell A. Meshing around: high-risk hernias and infected mesh. Trauma Surg Acute Care Open. 2024;9(Suppl 2):e001379.
https://doi.org/10.1136/tsaco-2024-001379
8. Sommerstein R, Troillet N, Harbarth S, de Kraker MEA, Vuichard-Gysin D, Kuster SP, et al. Timing of cefuroxime surgical antimicrobial prophylaxis and its association with surgical site infections. JAMA Netw Open. 2023;6(6):e2317370. https://doi.org/10.1001/jamanetworkopen.2023.17370
9. Ahmed NJ, Haseeb A, Alamer A, Almalki ZS, Alahmari AK, Khan AH, et al. Meta-analysis of clinical trials comparing cefazolin to cefuroxime, ceftriaxone, and cefamandole for surgical site infection prevention. Antibiotics (Basel). 2022;11(11):1543. https://doi.org/10.3390/antibiotics11111543
10. Rimmler C, Lanckohr C, Akamp C, Horn D, Fobker M, Wiebe K, et al. Physiologically based pharmacokinetic evaluation of cefuroxime in perioperative antibiotic prophylaxis. Br J Clin Pharmacol. 2019;85(12):2864-2877.
https://doi.org/10.1111/bcp.14121
11. Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML. Topical antibiotics for preventing surgical site infection in wounds healing by primary intention. Cochrane Database Syst Rev. 2016;11(11):CD011426.
https://doi.org/10.1002/14651858.CD011426.pub2.
12. Zhuo Y, Zhang Q, Tang D, Cai D. The effectiveness of iv cefuroxime prophylaxis of surgical site infection after elective inguinal hernia repair with mesh: a retrospective observational study. Eur J Clin Pharmacol. 2016;72(8):1033-1039.
https://doi.org/10.1007/s00228-016-2070-6
13. Al-Sa'adi MHJ, Alebady MHA, Allawi Zayer S. Comparison of the preventive efficacy of topical and injectable meropenem versus cefotaxime in preventing wound infection in umbilical hernia repair. J Babol Univ Med Sci. 2025;27:e13.
14. Bakhtiar U, Khan SA, Ahmed S, Pasha T. Efficacy of preoperative single dose antibiotic in patients undergoing mesh repair for inguinal hernia. J Ayub Med Coll Abbottabad. 2013;25(1-2):103-105.
15. Wijono H, Kristin F, Agustha Peerera BB, Herawati F, Yulia R. Meta-analysis on the effectiveness of the use of prophylactic antibiotics in preventing surgical site infection in patients with hernia surgery. In: Proceedings of the Conference on Natural Resources and Life Sciences 2022 (NRLS-BIO 2022). 2023.
https://doi.org/10.2991/978-94-6463-322-1_3
16. Khan S, Mehmood A, Khan R, Asad H. Role of intravenous cefuroxime antibiotic prophylaxis in the prevention of surgical site infection in open mesh inguinal hernia repair. Pak Armed Forces Med J. 2023;73(6):1835-1837.
17. Kulacoglu H. Hernia, mesh, and topical antibiotics, especially gentamycin: seeking the evidence for the perfect outcome. Front Surg. 2015;1:53.
https://doi.org/10.3389/fsurg.2014.00053
18. Yatimparvar G, Shafiee S, Ehteshami S, Shafizad M. Effect of topical vancomycin powder on the prevention of surgical site infections in craniotomy surgeries. Pak J Med Health Sci. 2020;14(2):1221-1225.
19. Borade SV, Syed O. Single dose antibiotic prophylaxis for prevention of surgical site infection in elective surgery. Int Surg J. 2018;5(1):27-33.
https://doi.org/10.18203/2349-2902.isj20175494
20. Sastry GL, Nandi M, Mukhopadhyay M, et al. Role of cefuroxime as antibiotic prophylaxis for general surgery: an expert opinion. IP J Surg Allied Sci. 2021;3(3):58-71.
https://doi.org/10.18231/j.jsas.2021.015
21. Masood A, Arshad AR, Ashraf M. Comparison between outcome of single dose of prophylactic antibiotic versus postoperative antibiotic in inguinal hernia surgery. Pak J Med Sci. 2022;38(5):1210-1215.
https://doi.org/10.12669/pjms.38.5.6597
22. Kulacoglu H. Current options in umbilical hernia repair in adult patients. Ulus Cerrahi Derg. 2015;31:157-161.
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