Usefulness of sonication procedure in mesh infection diagnosis associated with hernia repair
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ORIGINAL ARTICLE
Usefulness of sonication procedure in mesh infection diagnosis associated with hernia repair L. Salar‑Vidal1 · J. J. Aguilera‑Correa1 · E. Petkova2 · N. Carrasco‑Antón2 · A. Celdrán3 · J. Esteban1 Received: 19 December 2019 / Accepted: 30 December 2019 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background The use of prosthetic meshes is a common practice in hernia repair surgery. However, infection can appear as an important complication where antibiotic selection must be directed by the etiology of the infection. In recent years, sonication has appeared as an important tool for the diagnosis of many biomaterial-associated infections. Here, we evaluated our experience with this methodology for the diagnosis of mesh infection. Methods We retrospectively reviewed the microbiological records between 2015 and 2019 looking for sonicated meshes in the microbiology laboratory. All samples were processed according to the sonication protocol described by Esteban J et al. (J Clin Microbiol. 2008 Feb; 46 (2): 488–92). Results 26 samples were processed during the study period. 21 of them gave a positive result for culture (11 polymicrobial and 10 monomicrobial ones). Staphylococcus aureus and Candida albicans were the commonest monomicrobial isolates (4 cases each). There were five cases of mixed gut microbiota. The median (interquartile range) UFC count was > 100,000 (50,000- > 100,000) CFU/mL. Conclusion Sonication is a useful technique for the diagnosis of mesh infection. Keywords Sonication · Diagnosis · Biofilm · Mesh infection
Introduction The gold standard technique used in hernia repair surgery is prosthetic mesh implantation because it reduces hernia recurrence [1, 2]. However, despite its advantages, this procedure has some post-surgical complications, including seromas, adhesion, chronic severe pain, implant migration, intestinal obstruction and infection [1, 3, 4]. Mesh infection is one of the most important complications for the patient and it also implies an increased cost to the health-care system. The incidence rates range between 1 and 10%, depending on the type of mesh material, surgical * J. Esteban [email protected] 1
Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
2
Internal Medicine‑Sepsis Unit, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
3
General Surgery, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
technique used and population [2, 4–6]. The most common etiologic agents in mesh infection are Staphylococcus aureus, coagulase-negative Staphylococcus, Streptococcus sp., Enterobacteriaceae and anaerobic bacteria [1, 7]. The pathogenesis of this infection implies that the microorganism adheres to the mesh during surgical implantation, leading to biofilm formation on the biomaterial surface, altering implant integration and tissue regeneration [4, 8]. Prevention and non-surgical treatments for mesh infection ar
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