Oral, intestinal, and skin bacteria in ventral hernia mesh implants

Abstract

BackgroundIn ventral hernia surgery, mesh implants are used to reduce recurrence. Infection after mesh implantation can be a problem and rates around 6–10% have been reported. Bacterial colonization of mesh implants in patients without clinical signs of infection has not been thoroughly investigated. Molecular techniques have proven effective in demonstrating bacterial diversity in various environments and are able to identify bacteria on a gene-specific level.ObjectiveThe purpose of this study was to detect bacterial biofilm in mesh implants, analyze its bacterial diversity, and look for possible resemblance with bacterial biofilm from the periodontal pocket.MethodsThirty patients referred to our hospital for recurrence after former ventral hernia mesh repair, were examined for periodontitis in advance of new surgical hernia repair. Oral examination included periapical radiographs, periodontal probing, and subgingival plaque collection. A piece of mesh (1×1 cm) from the abdominal wall was harvested during the new surgical hernia repair and analyzed for bacteria by PCR and 16S rRNA gene sequencing. From patients with positive PCR mesh samples, subgingival plaque samples were analyzed with the same techniques.ResultsA great variety of taxa were detected in 20 (66.7%) mesh samples, including typical oral commensals and periodontopathogens, enterics, and skin bacteria. Mesh and periodontal bacteria were further analyzed for similarity in 16S rRNA gene sequences. In 17 sequences, the level of resemblance between mesh and subgingival bacterial colonization was 98–100% suggesting, but not proving, a transfer of oral bacteria to the mesh.ConclusionThe results show great bacterial diversity on mesh implants from the anterior abdominal wall including oral commensals and periodontopathogens. Mesh can be reached by bacteria in several ways including hematogenous spread from an oral site. However, other sites such as gut and skin may also serve as sources for the mesh biofilm.

Infections associated with mesh repairs of abdominal wall hernias: Are antimicrobial biomaterials the longed-for solution?

“…The authors of this work have demonstrated for the first time that hernia meshes could be reached by bacteria, not only originating from the skin and the gut of the patient, but also from oral site (due to periodontal diseases) [24]. This study suggests as well that bacterial biofilm settled on the meshes in patients without clinical signs of infection could a priori also promote recurrence [24].…”

“…In those complicated cases, the isolation, cultivation and identification of every causative agents still remains challenging and numerous pathogens may remain underestimated depending of the exact practices in the clinical microbiology lab [16,23]. The utilization of modern biotechnological tools such as gene sequencing has been recently employed as alternative to conventional cultivation methods to analyse the microbial population of explanted mesh following hernia recurrence [24]. The authors of this work have demonstrated for the first time that hernia meshes could be reached by bacteria, not only originating from the skin and the gut of the patient, but also from oral site (due to periodontal diseases) [24].…”

“…The utilization of modern biotechnological tools such as gene sequencing has been recently employed as alternative to conventional cultivation methods to analyse the microbial population of explanted mesh following hernia recurrence [24]. The authors of this work have demonstrated for the first time that hernia meshes could be reached by bacteria, not only originating from the skin and the gut of the patient, but also from oral site (due to periodontal diseases) [24]. This study suggests as well that bacterial biofilm settled on the meshes in patients without clinical signs of infection could a priori also promote recurrence [24].…”

Laparoscopic ventral hernia repair using only 5‐mm ports

“…Soaked mesh up to 15 cm in diameter can be pulled through a 5‐mm port site. A recent Norwegian publication demonstrates the association between hernia recurrence and mesh infection, suggesting that bacterial colonization of the mesh may occur in up to two thirds of those who present with recurrence . Reported rates of actual mesh infection vary between studies.…”

Prevention of patch infection after abdominal external hernia repair

“…S. epidermidis, β-hemolytic Streptococcus, Enterococcus, and anaerobic bacteria are also observed in the patch infection [12].…”