Skip to main content

Advertisement

SpringerLink
Log in

Gentamicin for prevention of intraoperative mesh contamination: demonstration of high bactericide effect (in vitro) and low systemic bioavailability (in vivo)

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Introduction

Mesh infection is a severe complication after incisional hernia repair and occurs in 1–3 % of all open mesh implantations. For this reason, topical antimicrobial agent applied directly to the mesh is often used procedure. So far, however, this procedure lacks a scientific basis.

Materials and methods

Two different meshes (Parietex™, Covidien; Ultrapro™, Ethicon Johnson & Johnson) were incubated with increasing amounts of three different Staphylococcus aureus strains (ATCC 25923; Mu50; ST239) with or without gentamicin and growth ability were determined in vitro. To further address the question of the systemic impact of topic gentamicin, serum levels were analyzed 6 and 24 h after implantation of gentamicin-impregnated multifilament meshes in 19 patients.

Results

None of the gentamicin-impregnated meshes showed any bacterial growth in vitro. This effect was independent of the mesh type for all the tested S. aureus strains. In the clinical setting, serum gentamicin levels 6 h after implantation of the gentamicin-impregnated meshes were below the through-level (range 0.4–2.9 mg/l, mean 1.2 ± 0.7 mg/l). After 24 h the gentamicin serum levels in all patients had declined 90–65 % of the 6 h values.

Conclusion

Local application of gentamicin to meshes can completely prevent the growth of even gentamicin-resistant S. aureus strains in vitro. The systemic relevance of gentamicin in the clinical controls showed to be very low, without reaching therapeutic concentrations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Badiou W, Lavigne JP, Bousquet PJ, O’Callaghan D, Marès P, de Tayrac R (1995) Aminoglycosides. Med Clin North Am 79(4):761–787

    Google Scholar 

  2. Cobb WS, Carbonell AM, Kalbaugh CL, Jones Y, Lokey JS (2009) Infection risk of open placement of intraperitoneal composite mesh. Am Surg 75(9):762–767

    PubMed  Google Scholar 

  3. Collage RD, Rosengart MR (2010) Abdominal wall infections with in situ mesh. Surg Infect (Larchmt) 11(3):311–318

    Article  Google Scholar 

  4. Dietz UA, Spor L, Germer CT (2011) Management of mesh related infections. Chirurg 82:208–217

    Article  PubMed  CAS  Google Scholar 

  5. Dietz UA, Winkler MS, Härtel RW, Fleischhacker A, Wiegering A, Isbert C, Jurowich C, Heuschmann P, Germer CT (2012) Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia. doi:10.1007/s10029-012-0999-x

    Google Scholar 

  6. Choi JJ, Palaniappa NC, Dallas KB, Rudich TB, Colon MJ, Divino CM (2012) Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases. Ann Surg 255(1):176–180

    Article  PubMed  Google Scholar 

  7. Hawn MT, Gray SH, Snyder CW, Graham LA, Finan KR, Vick CC (2011) Predictors of mesh explantation after incisional hernia repair. Am J Surg 202(1):28–33

    Article  PubMed  Google Scholar 

  8. Engelsman AF, van der Mei HC, Busscher HJ, Ploeg RJ (2008) Morphological aspects of surgical meshes as a risk factor for bacterial colonization. Br J Surg 95(8):1051–1059

    Article  PubMed  CAS  Google Scholar 

  9. Robinson TN, Clarke JH, Schoen J, Walsh MD (2005) Major mesh-related complications following hernia repair: events reported to the Food and Drug Administration. Surg Endosc 19(12):1556–1560

    Article  PubMed  CAS  Google Scholar 

  10. Greenberg JJ (2010) Can infected composite mesh be salvaged? Hernia 14(6):589–592

    Article  PubMed  CAS  Google Scholar 

  11. Aufenacker TJ, Koelemay MJ, Gouma DJ, Simons MP (2006) Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia. Br J Surg 93(1):5–10

    Article  PubMed  CAS  Google Scholar 

  12. Sanchez-Manuel FJ, Lozano-García J, Seco-Gil JL (2012) Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev 2:CD003769

    PubMed  Google Scholar 

  13. Wiegering A, Schlegel N, Isbert C, Jurowich C, Doht S, Germer CT, Dietz UA (2013) Lessons and challenges during a 5-year follow-up of 21 Composix Kugel implantations. Hernia 17(4):435–443

    Article  PubMed  CAS  Google Scholar 

  14. Brandt CJ, Kammer D, Fiebeler A, Klinge U (2011) Benefitial effects of hydrocortisone or spironolactone coating on foreign body response to mesh biomaterial in a mouse model. J Biomed Mater Res 99A(3):335–343

    Article  CAS  Google Scholar 

  15. Dietz UA, Hamelmann W, Winkler MS, Debus ES, Malafaia O, Czeczko NG, Thiede A, Kuhfuß I (2007) An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique. J Plast Reconstr Aesthet Surg 60(4):383–388

    Article  PubMed  CAS  Google Scholar 

  16. Bittner et al (2013) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias. Part I. Surg Endosc (accepted)

  17. Klinge U, Klosterhalfen B (2012) Modified classification of surgical meshes for hernia repair based on the analyses of 1,000 explanted meshes. Hernia 16(3):251–258

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. DeBord JR, Bauer JJ, Grischkan DM, LeBlanc KA, Smoot RT Jr, Voeller GR, Weiland LH (1999) Short-term study on the safety of antimicrobial-agent-impregnated ePTFE patches for hernia repair. Hernia 3:189–193

    Article  Google Scholar 

  19. Regis D, Sandri A, Samaila E, Benini A, Bondi M, Magnan B (2013) Release of gentamicin and vancomycin from preformed spacers in infected total hip arthroplasties: measurement of concentrations and inhibitory activity in patients’ drainage fluids and serum. Sci World J 22:e752184

    Google Scholar 

  20. Wang J, Zhu C, Cheng T, Peng X, Zhang W, Qin H, Zhang X (2013) A systematic review and meta-analysis of antibiotic-impregnated bone cement use in primary total hip or knee arthroplasty. PLoS One 8:e82745

    Article  PubMed  PubMed Central  Google Scholar 

  21. Engelsman AF, van der Mei HC, Ploeg RJ, Busscher HJ (2007) The phenomenon of infection with abdominal wall reconstruction. Biomaterials 28(14):2314–2327

    Article  PubMed  CAS  Google Scholar 

  22. Klosterhalfen B, Hermanns B, Rosch R, Junge K (2003) Biological response to mesh. Eur Surg 35:16–20

    Article  Google Scholar 

  23. Musella M, Guido A, Musella S (2001) Collagen tampons as aminoglycoside carriers to reduce postoperative infection rate in prosthetic repair of groin hernias. Eur J Surg 167(2):130–132

    Article  PubMed  CAS  Google Scholar 

  24. Letouzey V, Lavigne JP, Garric X, Coudane J, de Callaghan Tayrac DO (2011) Is degradable antibiotic coating for synthetic meshes provide protection against experimental animal infection after fascia repair? J Biomed Mater Res 100B(2):471–479

    Article  Google Scholar 

  25. Lortholary O, Tod M, Cohen Y, Petitjean O (1997) Antibiotic prophylaxis and open groin hernia repair. World J Surg 21(8):811–814

    Article  Google Scholar 

  26. Klinge U (2008) Mesh for hernia repair. Br J Surg 95:539–540

    Article  PubMed  CAS  Google Scholar 

  27. Binnebösel M, von Trotha KT, Ricken C, Klink CD, Junge K, Conze J, Jansen M, Neumann UP, Lynen Jansen P (2012) Gentamicin supplemented polyvinylidenfluoride mesh materials enhance tissue integration due to a transcriptionally reduced MMP-2 protein expression. BMC Surg 12:1. doi:10.1186/1471-2482-12-1

    Article  PubMed  PubMed Central  Google Scholar 

  28. Klink CD, Binnebösel M, Lambertz A, Alizai HP, Roeth A, Otto J, Klinge U, Neumann UP, Junge K (2012) In vitro and in vivo characteristics of gentamicin-supplemented polyvinylidenfluoride mesh materials. J Biomed Mater Res 100A(5):1195–1202

    Article  CAS  Google Scholar 

  29. Varghese JM, Roberts JA, Wallis SC, Boots RJ, Healy H, Fassett RG, Lipman J, Ranganathan D (2012) Pharmacokinetics of intraperitoneal gentamicin in peritoneal dialysis patients with peritonitis (GIPD study). Clin J Am Soc Nephrol 7(8):1249–1256

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  30. Blatnik JA, Krpata DM, Jacobs MR, Gao Y, Novitsky YW, Rosen MJ (2012) In vivo analysis of the morphologic characteristics of synthetic mesh to resist MRSA adherence. J Gastrointest Surg 16(11):2139–2144

    Article  PubMed  Google Scholar 

  31. Engelsman AF, van Dam GM, van der Mei HC, Busscher HJ, Ploeg RJ (2010) In vivo evaluation of bacterial infection involving morphologically different surgical meshes. Ann Surg 251(1):133–137

    Article  PubMed  Google Scholar 

  32. Geiger D, Debus ES, Ziegler UE, Larena-Avellaneda A, Frosch M, Thiede A, Dietz UA (2005) Capillary activity of surgical sutures and suture-dependent bacterial transport: a qualitative study. Surg Infect (Larchmt) 6(4):377–383

    Article  Google Scholar 

  33. Sadava EE, Krpata DM, Gao Y, Novitsky YW, Rosen MJ (2013) Does presoaking synthetic mesh in antibiotic solution reduce mesh infections? An experimental study. J Gastrointest Surg 17:562–628

    Article  PubMed  Google Scholar 

  34. Muysoms F, Campanelli G, Champault GG, DeBeaux AC, Dietz UA, Jeekel J, Klinge U, Köckerling F, Mandala V, Montgomery A, Morales Conde S, Puppe F, Simmermacher RK, Śmietański M, Miserez M (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16(3):239–250

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  35. Muysoms FE, Deerenberg EB, Peeters E, Agresta F, Berrevoet F, Campanelli G, Ceelen W, Champault GG, Corcione F, Cuccurullo D, Debeaux AC, Dietz UA, Fitzgibbons RJ Jr, Gillion JF, Hilgers RD, Jeekel J, Kyle-Leinhase I, Köckerling F, Mandala V, Montgomery A, Morales-Conde S, Simmermacher RK, Schumpelick V, Smietański M, Walgenbach M, Miserez M (2013) Recommendations for reporting outcome results in abdominal wall repair: results of a Consensus meeting in Palermo, Italy, 28-30 June 2012. Hernia 17(4):423–433

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

UK reports grants and personal fees from FEG-Textiltechnik, grants from Covidien, personal fees from expert testimony, personal fees from Ethicon, personal fees from B. Braun, outside the submitted manuscript.

Conflict of interest

AW, BS, LS, UK, US and CTG declare no conflicts of interest and no support from any organisation for the submitted work. UD makes known that he has or has had business relationships with the following companies: B.Braun-Aesculap, Covidien and Ethicon. Activities in connection with these companies include consulting, speaking, advising and research; UD is member of the EuraHS Board.

Author information

Authors and Affiliations

  1. Department of General, Visceral, Vascular and Pediatric Surgery (Department of Surgery I), University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany

    A. Wiegering, L. Spor, U. Steger, C. T. Germer & U. A. Dietz

  2. Department of Medical Microbiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands

    B. Sinha

  3. Institute for Hygiene and Microbiology, University Hospital of Wuerzburg, Josef-Schneider Strasse 2, 97080, Würzburg, Germany

    B. Sinha

  4. Surgical Department, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

    U. Klinge

Authors
  1. A. Wiegering
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Spor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Klinge
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Steger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. T. Germer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U. A. Dietz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. A. Dietz.

Additional information

A. Wiegering and B. Sinha contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wiegering, A., Sinha, B., Spor, L. et al. Gentamicin for prevention of intraoperative mesh contamination: demonstration of high bactericide effect (in vitro) and low systemic bioavailability (in vivo). Hernia 18, 691–700 (2014). https://doi.org/10.1007/s10029-014-1293-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-014-1293-x

Keywords

Search

Navigation