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Zheng T, Wang R, Wu C, Li S, Cao G, Zhang Y, Bu X, Jiang J, Kong Z, Miao Y, Zheng L, Tao G, Tao Q, Ding Z, Wang P, Ren J. Assessing morinidazole for surgical site infection in class III wounds prevention: a multi-centre, randomized, single-blind, parallel-controlled study. J Hosp Infect 2024; 151:186-194. [PMID: 38964506 DOI: 10.1016/j.jhin.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Surgical site infections (SSIs) are significant postoperative risks; antibiotic prophylaxis is crucial due to the presence of anaerobic bacteria. This study investigated the efficacy and safety of a novel nitroimidazole, morinidazole, in SSI reduction in class III wounds, as there is currently a lack of evidence in the existing literature. METHODS A multi-centre randomized clinical trial was conducted from December 2020 to October 2022 in the general surgery departments of 12 tertiary hospitals in China, including 459 patients in two treatment groups using morinidazole plus ceftriaxone or ceftriaxone alone. Efficacy and safety were evaluated including SSI incidence, adverse events, and compliance. Statistical analysis employed SAS 9.4 software. Data analysis was performed from February to May 2023. RESULTS A total of 440 participants (median (interquartile range, IQR) age, 63.0 (54.0, 70.0) years; 282 males (64.09%); 437 patients were of Han race (99.32%) and were randomized. The experimental group exhibited a significantly lower SSI rate compared with the control group (31 (14.49%) vs 52 (23.01%); risk difference, 1.76%, 95% confidence interval (CI) 1.08-2.88%; P=0.0224). The superficial incisional site infections revealed a marked reduction in the experimental group (12 (5.61%) vs 31 (13.37%); risk difference, 2.68%; 95% CI 1.34-5.36%; P=0.0042). Non-surgical site infections, severe postoperative complications, and total adverse events showed no statistically significant differences between the groups (P>0.05). CONCLUSION The significant decrease in SSI rates and superficial incisional infections demonstrates morinidazole to be a valuable prophylactic antibiotic. Our findings provide valuable insights for clinical practice, where this new-generation nitroimidazole can play a crucial role in SSI prevention.
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Affiliation(s)
- T Zheng
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - R Wang
- Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - C Wu
- Department of Emergency Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - S Li
- Department of Emergency Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - G Cao
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Y Zhang
- Department of Gastrointestinal Surgery, The People's Hospital of Maanshan, Maanshan, China
| | - X Bu
- Department of General Surgery, The First People's Hospital of Zhenjiang, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - J Jiang
- Department of General Surgery, Changshu No. 1 People's Hospital, Affiliated Changshu Hospital of Soochow University, Suzhou, China
| | - Z Kong
- Department of General Surgery, The First People's Hospital of Taicang, Taicang Affiliated Hospital of Soochow University, Suzhou, China
| | - Y Miao
- The General Surgery Department of Second People's Hospital of Lianyungang & The General Surgery Department Oncology Hospital of Lianyungang, Lianyungang, China
| | - L Zheng
- General Surgery Department. Nanjing Jiangbei Hospital, Nanjing, China
| | - G Tao
- Department of General Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
| | - Q Tao
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Z Ding
- Department of General Surgery, Wuxi Traditional Chinese Medicine Hospital Affiliated to Nanjing Traditional Chinese Medicine University, Wuxi, China
| | - P Wang
- Department of Emergency Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - J Ren
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China.
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Marcolin P, Oliveira Trindade B, Bueno Motter S, Brandão GR, Messer N, Mazzola Poli de Figueiredo S. The impact of smoking on inguinal hernia repair outcomes: a meta-analysis of multivariable-adjusted studies. Hernia 2024; 28:1029-1037. [PMID: 38717561 DOI: 10.1007/s10029-024-03049-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/14/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE While the detrimental effects of smoking on postoperative outcomes are recognized, the extent of its risk for inguinal hernia repair remains unclear. Our study aims to assess the influence of smoking on patients who undergo inguinal hernia repair. METHODS We systematically reviewed PubMed, Embase, and Cochrane databases. Our goal was to identify studies that compared postoperative outcomes in smoking and non-smoking patients after inguinal hernia repair, and which employed a multivariate analysis to reduce possible confounding factors. Outcomes were recurrence, postoperative complications, and surgical site infection. Odds ratios (ORs) with 95% confidence intervals (CIs) were computed with the use of a random-effects model. Heterogeneity was examined with I2 statistics. This review was prospectively registered in PROSPERO (CRD42023445513). RESULTS Our analysis encompassed 11 studies, involving a total of 577,901 patients. Of these, 77,226 (or 13.4%) identified as smokers, with males constituting 90% of the cohort. In terms of surgical approaches, 58% underwent laparoscopic procedures were most common at 58%, followed by open surgeries at 41%, and 1% used robotic techniques. All included studies had a low risk of bias. Smoking was associated with a higher incidence of hernia recurrence (OR 2.95; 95% CI 2.08 to 4.18; p < 0.001; I2 = 0%). No differences were found in postoperative complication (OR 1.15; 95% CI 1.00 to 1.32; p = 0.05; I2 = 56%) or surgical site infection (OR 2.94; 95% CI 0.80 to 10.88; p = 0.11; I2 = 79%). CONCLUSION Smoking was associated with a three-fold increase in recurrence. Further studies are needed to evaluate the impact of preoperative smoking cessation on reducing recurrence.
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Affiliation(s)
- P Marcolin
- Division of Surgery, Federal University of the Southern Border (Universidade Federal da Fronteira Sul), 20 Capitão Araujo St, Passo Fundo, 99010-121, Brazil.
| | - B Oliveira Trindade
- Division of Surgery, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil
| | - S Bueno Motter
- Division of Surgery, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil
| | - G R Brandão
- Division of Surgery, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil
| | - N Messer
- Division of Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - S Mazzola Poli de Figueiredo
- Division of Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Zhuo Y, Cai D, Chen J, Zhang Q, Li X. Pre-surgical peripheral blood inflammation markers predict surgical site infection following mesh repair of groin hernia. Medicine (Baltimore) 2021; 100:e25007. [PMID: 33655970 PMCID: PMC7939215 DOI: 10.1097/md.0000000000025007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/28/2020] [Accepted: 02/05/2021] [Indexed: 02/05/2023] Open
Abstract
Surgical site infection (SSI) is a costly postoperative complication with a decrease in the quality of life. We aimed to probe the predictive role of peripheral blood inflammation markers for SSI following mesh repair of groin hernia (GH).This retrospective study assessed the data of 1177 patients undergoing elective mesh repair of GH (open/laparoscopy) in the absence of antibiotic prophylaxis. The relation between demographics, surgical factors, pre-surgical laboratory results and the occurrence of SSI were investigated by univariate and multivariate analyses. Receiver operating characteristic analysis was performed to determine the optimal threshold of parameters and compare their veracity.The overall SSI rate was 3.2% with 1-year follow-up (38 superficial and 1 deep SSI). Patients with SSI had significant higher pre-surgical neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) than those without (P = .029 and P = .045, respectively); their NLR and PLR correlated positively with postoperative total days of antibiotic treatment for SSI (r = .689, P = .000; r = .493, P = .001; respectively). NLR and PLR had larger areas under the receiver operating characteristics curves than neutrophil (.875 vs. .601; P = .000; .726 vs. .601; P = .017). The combination of PLR and neutrophil/NLR raised the predictive sensitivity of PLR for SSI (sensitivity: PLR: 74.36%; PLR + neutrophil: 82.05%; PLR + NLR: 83.57%). On multivariate analyses, higher preoperative NLR (cut-off 2.44) and PLR (cut-off 125.42) were independent predictors for SSI.Higher pre-surgical NLR and PLR may be valuable predictors for SSI following elective mesh repair of GH.
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Affiliation(s)
| | - De Cai
- Department of Clinical Pharmacy
| | - Juntian Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Rd, Shantou, China
| | | | - Xinxin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Rd, Shantou, China
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Rajapaksha K, Herath A, M. Silva LJC, D. Anandappa MJ, G. Bandara TMI. Prophylactic antibiotic for open mesh repair of inguinal hernia; from principe to nécessité. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2019. [DOI: 10.4103/ijawhs.ijawhs_2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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