BN SO48 - Antibiotic prescribing for elective inguinal hernia repairs

Abstract Background Inguinal hernia repairs are a common procedure with over one million operations performed annually in Europe and the US. The European Hernia Society do not recommend the routine use of antibiotics in low-risk patients due to no significant benefit. They advise the consideration of prophylaxis for patients with risk factors including recurrence, age > 70 years or immunosuppression. Many surgeons are using antibiotic prophylaxis in all patients. However, inappropriate antibiotic use contributes to increased antibiotic resistance and increased healthcare cost. Our trust guidelines recommend a single dose of Cefuroxime in all patients undergoing an inguinal hernia repair with mesh. Method The aim of the project was to determine the compliance with current trust guidelines regarding antibiotic use in elective inguinal hernia repair with mesh. We also aimed to report on antibiotic prescribing patterns. Patients undergoing an elective inguinal hernia repair with mesh over a six-month period were identified. Data was collected retrospectively from electronic patient records and included patient’s age, if they were classed as high risk (age over 70, recurrence of hernia, diabetic, steroid therapy), if antibiotics were prescribed, and if so, which antibiotics were utilised. Results Eighty-five patients were included in the final data analysis. The median age of patients included was 67 years of age, and 93% were male. 41 patients were identified as high risk, and most patients were ASA II. Our results reported that 48% of patients were prescribed prophylactic antibiotics at induction. However, only two patients were prescribed the correct antibiotic, as per trust guidelines. Most patients were prescribed Co-Amoxiclav (78%), with a range of other antibiotics being used, including Flucloxacillin, Clarithromycin and Metronidazole. We identified 37% of high-risk patients were not prescribed antibiotics. Conclusion Our trust guidelines were not reflective of best practice and did not consider individual patient or procedure risk factors. We identified varied antibiotic prescribing patterns with low compliance to trust guidelines. Utilising our findings, we have created new guidelines, which recommend that in low-risk patients, routine antibiotic prophylaxis is not required. However, in the presence of patient-related risk factors as mentioned above, then a single dose of Cefuroxime is recommended. The updated guidelines will ensure good antimicrobial stewardship and reduce unnecessary antibiotic prescriptions. In addition, they accurately reflect the current evidence base surrounding antibiotic prophylaxis.