An in vitro study assessing the effect of mesh morphology and suture fixation on bacterial adherence
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ORIGINAL ARTICLE
An in vitro study assessing the effect of mesh morphology and suture fixation on bacterial adherence D. Sanders • J. Lambie • P. Bond • R. Moate J. A. Steer
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Received: 22 September 2012 / Accepted: 8 June 2013 Ó Springer-Verlag France 2013
Abstract Purpose Prosthetic infections, although relatively uncommon in hernia surgery, are a source of considerable morbidity and cost. The aims of this experimental study were to assess the influence of the morphological properties of the mesh on bacterial adherence in vitro. The morphological properties assessed were the polymer type, filament type, filament diameter, mesh weight, mean pore size, and the addition of silver chlorhexidine and titanium coatings. In addition, the study assessed the effect on bacterial adherence of adding a commonly used suture to the mesh and compared adherence rates to self-gripping mesh that does not require suture fixation. Methods Eight commercially sourced flat hernia meshes with different material characteristics were included in the study. These were ProleneÒ (EthiconÒ), DualMeshÒ (GoreÒ), DualMeshÒ Plus (GoreÒ), ParietexTM ProGrip (CovidienTM), TiMeshÒ Light (GfE Medical), BardÒ Soft Mesh (BardÒ), VyproÒ (EthiconÒ), and OmyraÒ (BraunÒ). Individual meshes were inoculated with Staphylococcus
D. Sanders J. A. Steer Peninsula College of Medicine and Dentistry, John Bull Building, Tamar Science Park, Plymouth PL6 8BU, UK D. Sanders (&) Department of Upper GI Surgery, The Royal Cornwall Hospital, Truro TR1 3LJ, UK e-mail: [email protected] J. Lambie P. Bond R. Moate Plymouth Electron Microscopy Centre, Plymouth University, Drake Circus, Plymouth PL4 8AA, UK J. A. Steer Department of Microbiology, Derriford Hospital, Plymouth PL6 8DH, UK
epidermidis and Staphylococcus aureus with a bacterial inoculum of 102 bacteria. To assess the effect of suture material on bacterial adhesion, a sterile piece of commonly used monofilament suture material (2.0 ProleneÒ, ZB370 EthiconÒ) was sutured to selected meshes (chosen to represent different commonly used polymers and/or the presence of an antibacterial coating). Inoculated meshes were incubated for 18 h in tryptone soy broth and then analysed using scanning electron microscopy. A previously validated method for enumeration of bacteria using automated stage movement electron microscopy was used for direct bacterial counting. The final fraction of the bacteria adherent to the mesh was compared between the meshes and for each morphological variable. One-way analysis of variance (ANOVA) was performed on the bacterial counts. Tukey’s test was used to determine the difference between the different biomaterials in the event the ANOVA was significant. Results Properties that significantly increased the mean bacterial adherence were the expanded polytetrafluoroethylene polymer (P \ 0.001); multifilament meshes (P \ 0.001); increased filament diameter (P \ 0.001); increased mesh weight (P \ 0.001); and smaller mean pore size (P \ 0.001). In contrast, mesh coating with antibacteria
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