Abstract
Background
Synthetic mesh has significantly reduced recurrence rates for ventral hernia repair; however, prosthetic mesh infections remain a significant complication. We hypothesized that unique mesh constructs might alter the ability of various synthetic meshes to clear bacterial contamination. To evaluate this, we studied commercially available synthetic meshes ability to clear a bacterial contamination with methicillin resistant Staphylococcus aureus infection.
Methods
Two hundred and eighty-three rats underwent hernia repair with one of nine synthetic materials. Control animals were closed, and the remainder was inoculated with either 104 or 106 methicillin-resistant S. aureus (MRSA). Animals were survived for 30 days without systemic antibiotics. At necropsy, the mesh was harvested and quantitative cultures and bacterial clearance assessed.
Results
All clean repairs remained sterile. Rates of bacterial clearance for 104 repairs revealed that unprotected monofilament materials cleared significantly more bacteria than composite meshes and multifilament meshes (p = <0.01 and p = 0.01, respectively). At higher levels of bacterial contamination (106), all materials had a reduction in bacterial clearance, although monofilament materials had higher bacterial clearance compared to composite meshes (p = 0.03).
Conclusions
Monofilament unprotected polypropylene and polyester mesh can clear a large percentage of MRSA contaminants. Multifilament, composite anti-adhesive barrier meshes, and laminar antimicrobial impregnated mesh are not able to clear bacterial contamination with MRSA. Unique properties of synthetic material should be considered when evaluating a prosthetic for high-risk incisional hernia repair.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Luijendijk, R.W., et al., A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med, 2000. 343(6): p. 392–8.
Engelsman, A.F., et al., In vivo evaluation of bacterial infection involving morphologically different surgical meshes. Ann Surg, 2010. 251(1): p. 133–7.
Engelsman, A.F., et al., The phenomenon of infection with abdominal wall reconstruction. Biomaterials, 2007. 28(14): p. 2314–27.
Burger, J.W., et al., Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg, 2004. 240(4): p. 578–83; discussion 583–5.
Hesselink, V.J., et al., An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet, 1993. 176(3): p. 228–34.
Engelsman, A.F., et al., Morphological aspects of surgical meshes as a risk factor for bacterial colonization. Br J Surg, 2008. 95(8): p. 1051–9.
Halaweish, I., et al., Novel in vitro model for assessing susceptibility of synthetic hernia repair meshes to Staphylococcus aureus infection using green fluorescent protein-labeled bacteria and modern imaging techniques. Surg Infect (Larchmt), 2010. 11(5): p. 449–54.
Klinge, U., et al., Functional and morphological evaluation of a low-weight, monofilament polypropylene mesh for hernia repair. J Biomed Mater Res, 2002. 63(2): p. 129–36.
An, Y.H. and R.J. Friedman, Concise review of mechanisms of bacterial adhesion to biomaterial surfaces. J Biomed Mater Res, 1998. 43(3): p. 338–48.
Davidson, C.A. and C.R. Lowe, Optimisation of polymeric surface pre-treatment to prevent bacterial biofilm formation for use in microfluidics. J Mol Recognit, 2004. 17(3): p. 180–5.
Gottenbos, B., H.C. van der Mei, and H.J. Busscher, Initial adhesion and surface growth of Staphylococcus epidermidis and Pseudomonas aeruginosa on biomedical polymers. J Biomed Mater Res, 2000. 50(2): p. 208–14.
Harrell, A.G., et al., In vitro infectability of prosthetic mesh by methicillin-resistant Staphylococcus aureus. Hernia, 2006. 10(2): p. 120–4.
Carbonell, A.M., et al., Susceptibility of prosthetic biomaterials to infection. Surg Endosc, 2005. 19(12): p. 1670.
Conflict of interest
Yuri Novitsky discloses being a speaker for Lifecell, Davol and a consultant for Davol, Kensey Nash. Michael Rosen discloses being a speaker for Lifecell. Research supports are from Lifecell, Davol, W.L. Gore, and Cook.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Blatnik, J.A., Krpata, D.M., Jacobs, M.R. et al. In Vivo Analysis of the Morphologic Characteristics of Synthetic Mesh to Resist MRSA Adherence. J Gastrointest Surg 16, 2139–2144 (2012). https://doi.org/10.1007/s11605-012-1992-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-012-1992-5