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History of methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection may not be a contraindication to ventral hernia repair with synthetic mesh: a preliminary report

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Abstract

Purpose

A history of methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection presents a significant surgical dilemma as to the risk of subsequent mesh infection, even if no active infection is present. We investigated the outcomes of ventral hernia repair with synthetic mesh in patients with prior MRSA surgical site infections (SSIs).

Methods

All patients with a clean wound but prior MRSA SSI undergoing open ventral hernia repair with mesh by a single surgeon over a 3-year period were reviewed for the development of any major (need for readmission, operative debridement, or mesh removal) or minor SSI. All patients received peri-operative intravenous vancomycin and prolonged suppressive oral trimethoprim/sulfamethoxazole or doxycycline.

Results

Ten patients (male = 7, female = 3) with clean wounds and a history of MRSA SSI underwent open ventral hernia repair with retrorectus synthetic mesh placement. Mean follow-up was 13.5 ± 3.3 months. Overall, two patients (20 %) developed SSIs (minor = 2, major = 0). Both SSIs were successfully managed with therapeutic oral antibiotics and local wound care without need for surgical debridement or mesh removal. There have been no hernia recurrences in any of the patients.

Conclusions

Preliminary results suggest that history of MRSA infection may not be a contraindication to the use of synthetic mesh for ventral hernia repair. Macroporous lightweight meshes, combined with use of prolonged suppressive antibiotics and sublay retromuscular mesh placement that provides complete tissue coverage, should be further investigated as an acceptable prosthetic choice when planning a complex ventral hernia repair in the setting of prior MRSA SSI.

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References

  1. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398

    Article  CAS  PubMed  Google Scholar 

  2. Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554

    Article  CAS  PubMed  Google Scholar 

  3. White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64:276–280

    CAS  PubMed  Google Scholar 

  4. Leber GE, Garb JL, Alexander AI, Reed WP (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133:378–382

    Article  CAS  PubMed  Google Scholar 

  5. Petersen S, Henke G, Freitag M, Faulhaber A, Ludwig K (2001) Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg 167:453–457

    Article  CAS  PubMed  Google Scholar 

  6. Cobb WS, Carbonell AM, Kalbaugh CL, Jones Y, Lokey JS (2009) Infection risk of open placement of intraperitoneal composite mesh. Am Surg 75:762–767 (discussion 767–768)

    PubMed  Google Scholar 

  7. Engemann JJ, Carmeli Y, Cosgrove SE, Fowler VG, Bronstein MZ, Trivette SL, Briggs JP, Sexton DJ, Kaye KS (2003) Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 36:592–598

    Article  PubMed  Google Scholar 

  8. Jezupovs A, Mihelsons M (2006) The analysis of infection after polypropylene mesh repair of abdominal wall hernia. World J Surg 30:2270–2278 (discussion 2279–2280)

    Article  PubMed  Google Scholar 

  9. Swenson BR, Camp TR, Mulloy DP, Sawyer RG (2008) Antimicrobial-impregnated surgical incise drapes in the prevention of mesh infection after ventral hernia repair. Surg Infect (Larchmt) 9:23–32

    Article  Google Scholar 

  10. Sitzmann JV, McFadden DW (1989) The internal retention repair of massive ventral hernia. Am Surg 55:719–723

    CAS  PubMed  Google Scholar 

  11. Houck JP, Rypins EB, Sarfeh IJ, Juler GL, Shimoda KJ (1989) Repair of incisional hernia. Surg Gynecol Obstet 169:397–399

    CAS  PubMed  Google Scholar 

  12. Blatnik JA, Krpata DM, Novitsky YW, Rosen MJ (2012) Does a history of wound infection predict postoperative surgical site infection after ventral hernia repair? Am J Surg 203(3):370–374

    Google Scholar 

  13. Klinge U, Junge K, Spellerberg B, Piroth C, Klosterhalfen B, Schumpelick V (2002) Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model. J Biomed Mater Res 63:765–771

    Article  CAS  PubMed  Google Scholar 

  14. Harrell AG, Novitsky YW, Kercher KW, Foster M, Burns JM, Kuwada TS, Heniford BT (2006) In vitro infectability of prosthetic mesh by methicillin-resistant Staphylococcus aureus. Hernia 10:120–124

    Article  CAS  PubMed  Google Scholar 

  15. Aydinuraz K, Agalar C, Agalar F, Ceken S, Duruyurek N, Vural T (2009) In vitro S. epidermidis and S. aureus adherence to composite and lightweight polypropylene grafts. J Surg Res 157:e79–e86

    Article  CAS  PubMed  Google Scholar 

  16. 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 251:133–137

    Article  PubMed  Google Scholar 

  17. Trunzo JA, Ponsky JL, Jin J, Williams CP, Rosen MJ (2009) A novel approach for salvaging infected prosthetic mesh after ventral hernia repair. Hernia 13:545–549

    Article  CAS  PubMed  Google Scholar 

  18. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278 (quiz 279–280)

    Article  CAS  PubMed  Google Scholar 

  19. den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev (3):CD006438

  20. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237:129–135

    Article  PubMed  Google Scholar 

  21. Farrow B, Awad S, Berger DH, Albo D, Lee L, Subramanian A, Bellows CF (2008) More than 150 consecutive open umbilical hernia repairs in a major Veterans Administration Medical Center. Am J Surg 196:647–651

    Article  PubMed  Google Scholar 

  22. Spear SL, Seruya M (2010) Management of the infected or exposed breast prosthesis: a single surgeon’s 15-year experience with 69 patients. Plast Reconstr Surg 125:1074–1084

    Article  CAS  PubMed  Google Scholar 

  23. Kilgus DJ, Howe DJ, Strang A (2002) Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res (404):116–124

  24. Salgado CD, Dash S, Cantey JR, Marculescu CE (2007) Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res 461:48–53

    PubMed  Google Scholar 

  25. Mittal Y, Fehring TK, Hanssen A, Marculescu C, Odum SM, Osmon D (2007) Two-stage reimplantation for periprosthetic knee infection involving resistant organisms. J Bone Joint Surg Am 89:1227–1231

    Article  PubMed  Google Scholar 

  26. Centers for Medicare and Medicaid Services (2006) Hospital quality alliance 2004–2007 measure build out table. http://www.cms.hhs.gov/HospitalQualityInits/downloads/HospitalHQA2004_2007200512.pdf. Accessed 22 Dec 2011

  27. Edwards C, Angstadt J, Whipple O, Grau R (2005) Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma-related cellulitis. Am Surg 71:931–935 (discussion 935–936)

    CAS  PubMed  Google Scholar 

  28. Rao N, Crossett LS, Sinha RK, Le Frock JL (2003) Long-term suppression of infection in total joint arthroplasty. Clin Orthop Relat Res (414):55–60

  29. Brandt CM, Sistrunk WW, Duffy MC, Hanssen AD, Steckelberg JM, Ilstrup DM, Osmon DR (1997) Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis 24:914–919

    Article  CAS  PubMed  Google Scholar 

  30. Segreti J, Nelson JA, Trenholme GM (1998) Prolonged suppressive antibiotic therapy for infected orthopedic prostheses. Clin Infect Dis 27:711–713

    Article  CAS  PubMed  Google Scholar 

  31. Bellon JM, Garcia-Carranza A, Jurado F, Garcia-Honduvilla N, Carrera-San Martin A, Bujan J (2001) Peritoneal regeneration after implant of a composite prosthesis in the abdominal wall. World J Surg 25:147–152

    Article  CAS  PubMed  Google Scholar 

  32. Duffy AJ, Hogle NJ, LaPerle KM, Fowler DL (2004) Comparison of two composite meshes using two fixation devices in a porcine laparoscopic ventral hernia repair model. Hernia 8:358–364

    Article  CAS  PubMed  Google Scholar 

  33. Gonzalez R, Rodeheaver GT, Moody DL, Foresman PA, Ramshaw BJ (2004) Resistance to adhesion formation: a comparative study of treated and untreated mesh products placed in the abdominal cavity. Hernia 8:213–219

    Article  CAS  PubMed  Google Scholar 

  34. Gonzalez R, Fugate K, McClusky D III, Ritter EM, Lederman A, Dillehay D, Smith CD, Ramshaw BJ (2005) Relationship between tissue ingrowth and mesh contraction. World J Surg 29:1038–1043

    Article  PubMed  Google Scholar 

  35. Burger JW, Halm JA, Wijsmuller AR, ten Raa S, Jeekel J (2006) Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc 20:1320–1325

    Article  CAS  PubMed  Google Scholar 

  36. Novitsky YW, Cristiano JA, Harrell AG, Newcomb W, Norton JH, Kercher KW, Heniford BT (2008) Immunohistochemical analysis of host reaction to heavyweight-, reduced-weight-, and expanded polytetrafluoroethylene (ePTFE)-based meshes after short- and long-term intraabdominal implantations. Surg Endosc 22:1070–1076

    Article  CAS  PubMed  Google Scholar 

  37. Orenstein SB, Saberski ER, Kreutzer DL, Novitsky YW (2011) Comparative analysis of histopathologic effects of synthetic meshes based on material, weight, and pore size in mice. J Surg Res 176(2):423–429

    Google Scholar 

  38. Amid PK, Shulman AG, Lichtenstein IL, Hakakha M (1994) Biomaterials for abdominal wall hernia surgery and principles of their applications. Langenbecks Arch Chir 379:168–171

    Article  CAS  PubMed  Google Scholar 

  39. Demirer S, Gecim IE, Aydinuraz K, Ataoglu H, Yerdel MA, Kuterdem E (2001) Affinity of Staphylococcus epidermidis to various prosthetic graft materials. J Surg Res 99:70–74

    Article  CAS  PubMed  Google Scholar 

  40. Bauer JJ, Salky BA, Gelernt IM, Kreel I (1987) Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE). Ann Surg 206:765–769

    Article  CAS  PubMed  Google Scholar 

  41. Schuster R, Singh J, Safadi BY, Wren SM (2006) The use of acellular dermal matrix for contaminated abdominal wall defects: wound status predicts success. Am J Surg 192:594–597

    Article  CAS  PubMed  Google Scholar 

  42. Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ (2012) Posterior and open anterior components separations: a comparative analysis. Am J Surg 203(3):318–322

    Google Scholar 

  43. Rosen MJ (2012) Atlas of abdominal wall reconstruction. Elsevier/Saunders, Philadelphia

    Google Scholar 

  44. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399 (discussion 399–400)

    PubMed  Google Scholar 

  45. Rosen MJ (2009) Polyester-based mesh for ventral hernia repair: is it safe? Am J Surg 197:353–359

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was completed in the Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH without financial support.

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Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    C. W. Hicks

  2. Department of Surgery, Division of GI and General Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    J. A. Blatnik, D. M. Krpata, Y. W. Novitsky & M. J. Rosen

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  1. C. W. Hicks
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  2. J. A. Blatnik
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  3. D. M. Krpata
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  4. Y. W. Novitsky
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Correspondence to C. W. Hicks.

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Hicks, C.W., Blatnik, J.A., Krpata, D.M. et al. History of methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection may not be a contraindication to ventral hernia repair with synthetic mesh: a preliminary report. Hernia 18, 65–70 (2014). https://doi.org/10.1007/s10029-012-1035-x

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  • DOI: https://doi.org/10.1007/s10029-012-1035-x

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