Antibiotic prophylaxis in hernia repair and breast surgery: a prospective
randomized study comparing piperacillin/tazobactam versus placebo.
Author(s): Esposito S, Leone S, Noviello S, Ianniello F, Marvaso A, Cuniato V, Bellitti F.
Affiliation(s): Department of Infectious Diseases, Second University of Naples, Naples, Italy.
silvanoesposito@libero.it
Publication date & source: 2006, J Chemother. , 18(3):278-84
Although antibiotic prophylaxis is not explicitly indicated for hernia repair and
breast surgery, its use for these clean procedures is widely adopted, albeit to a
different extent in different countries, often on the personal decision of the
individual surgeon. The present study was carried out to compare the efficacy of
a single pre-operative dose of piperacillin-tazobactam with placebo in preventing
surgical wound infections and to determine the main risk factors associated with
infections following two main elective surgical clean procedures such as hernia
repair and breast surgery.A total of 501 patients undergoing elective
inguinal/femoral hernia repair or breast surgery were enrolled in this
prospective randomized clinical study. Patients were randomly assigned to receive
preoperative antibiotic prophylaxis or placebo. One dose of
piperacillin-tazobactam 2.250 g or placebo was administered i.v. 30 minutes prior
to the surgical procedure. Using statistical univariate analysis, the following
variables were correlated with a higher infection risk: age >40 years,
concomitant disease, WBC <3500, surgical wound size >9cm, use of drainages,
non-prophylaxis. Using multivariate analysis, no antibiotic pre-operative
prophylaxis, concurrent chronic diseases, especially diabetes (risk 15 times
higher), and length of intervention >45 min (risk 6 times higher) were
independent predictors of infection. Finally, patients with postoperative
infections had a significantly longer hospitalisation. One pre-operative dose of
piperacillin-tazobactam 2.250 g is more effective than placebo in preventing
postoperative infections in breast surgery and hernia repair.
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