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Schmitz SM, Helmedag MJ, Kroh A, Heise D, Klinge U, Lambertz A, Hornef MW, Neumann UP, Eickhoff RM. Choice of Polymer, but Not Mesh Structure Variation, Reduces the Risk of Bacterial Infection with Staphylococcus aureus In Vivo. Biomedicines 2023; 11:2083. [PMID: 37509722 PMCID: PMC10377515 DOI: 10.3390/biomedicines11072083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Synthetic mesh material is of great importance for surgical incisional hernia repair. The physical and biochemical characteristics of the mesh influence mechanical stability and the foreign body tissue reaction. The influence on bacterial infections, however, remains ill-defined. The aim of the present study was to evaluate the influence of a modified mesh structure with variation in filament linking on the occurrence of bacterial infection that is indicated by the occurrence of CD68+, CD4+, and CD8+ cells in two different materials. METHODS A total of 56 male Sprague Dawley rats received a surgical mesh implant in a subcutaneous abdominal position. The mesh of two different polymers (polypropylene (PP) and polyvinylidenfluoride (PVDF)) and two different structures (standard structure and bold structure with higher filament linking) were compared. During the implantation, the meshes were infected with Staphylococcus (S.) aureus. After 7 and 21 days, meshes were explanted, and the early and late tissue responses to infection were histologically evaluated. RESULTS Overall, the inflammatory tissue response was higher at 7 days when compared to 21 days. At 7 days, PP meshes of the standard structure (PP-S) showed the strongest inflammatory tissue response in comparison to all the other groups. At 21 days, no statistically significant difference between different meshes was detected. CD8+ cytotoxic T cells showed a significant difference at 21 days but not at 7 days. PP meshes of both structures showed a higher infiltration of CD8+ T cells than PVDF meshes. CD4+ T helper cells differed at 7 days but not at 21 days, and PVDF meshes in a bold structure showed the highest CD4+ T cell count. The number of CD68+ macrophages was also significantly higher in PP meshes in a standard structure when compared to PVDF meshes at 21 days. CONCLUSION The inflammatory tissue response to S. aureus infection appears to be highest during the early period after mesh implantation. PP meshes showed a higher inflammatory response than PVDF meshes. The mesh material appears to be more important for the risk of infection than the variation in filament linking.
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Affiliation(s)
- Sophia M Schmitz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Marius J Helmedag
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Daniel Heise
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Uwe Klinge
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Mathias W Hornef
- Department of Medical Microbiology, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Ulf P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Roman M Eickhoff
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
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Morrison BG, Gledhill K, Plymale MA, Davenport DL, Roth JS. Comparative long-term effectiveness between ventral hernia repairs with biosynthetic and synthetic mesh. Surg Endosc 2023:10.1007/s00464-023-10082-1. [PMID: 37118030 DOI: 10.1007/s00464-023-10082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Debate exists regarding the most appropriate type of mesh to use in ventral hernia repair (VHR). Meshes are broadly categorized as synthetic or biologic, each mesh with individual advantages and disadvantages. More recently developed biosynthetic mesh has characteristics of both mesh types. The current study aims to examine long-term follow-up data and directly compare outcomes-specifically hernia recurrence-of VHR with biosynthetic versus synthetic mesh. METHODS With IRB approval, consecutive cases of VHR (CPT codes 49,560, 49,561, 49,565, and 49,566 with 49,568) performed between 2013 and 2018 at a single institution were reviewed. Local NSQIP data was utilized for patient demographics, perioperative characteristics, CDC Wound Class, comorbidities, and mesh type. A review of electronic medical records provided additional variables including hernia defect size, postoperative wound events to six months, duration of follow-up, and incidence of hernia recurrence. Longevity of repair was measured using Kaplan-Meier method and adjusted Cox proportional hazards regression. RESULTS Biosynthetic mesh was used in 101 patients (23%) and synthetic mesh in 338 (77%). On average, patients repaired using biosynthetic mesh were older than those with synthetic mesh (57 vs. 52 years; p = .008). Also, ASA Class ≥ III was more common in biosynthetic mesh cases (70.3% vs. 55.1%; p = .016). Patients repaired with biosynthetic mesh were more likely than patients with synthetic mesh to have had a prior abdominal infection (30.7% vs. 19.8%; p = .029). Using a Kaplan-Meier analysis, there was not a significant difference in hernia recurrence between the two mesh types, with both types having Kaplan Meir 5-year recurrence-free survival rates of about 72%. CONCLUSION Using Kaplan-Meier analysis, synthetic mesh and biosynthetic mesh result in comparable hernia recurrence rates and surgical site infection rates in abdominal wall reconstruction patients with follow-up to as long as five years.
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Affiliation(s)
| | - Kiah Gledhill
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Margaret A Plymale
- Division of General, Endocrine & Metabolic Surgery, Department of Surgery, University of Kentucky, C 240, Chandler Medical Center, 800 Rose Street, Lexington, KY, 40536, USA
| | - Daniel L Davenport
- Division of Health Outcomes and Optimal Patient Services, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - John S Roth
- Division of General, Endocrine & Metabolic Surgery, Department of Surgery, University of Kentucky, C 240, Chandler Medical Center, 800 Rose Street, Lexington, KY, 40536, USA.
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Comparative Effectiveness Analysis of Resorbable Synthetic Onlay and Biologic Intraperitoneal Mesh for Abdominal Wall Reconstruction: A 2-Year Match-Paired Analysis. Plast Reconstr Surg 2022; 149:1204-1213. [PMID: 35311754 DOI: 10.1097/prs.0000000000009021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominal wall reconstruction persists as a challenging surgical issue with a multitude of management strategies available. The aim of this study was to examine the efficacy of resorbable synthetic mesh onlay plane against biologic mesh in the intraperitoneal plane. METHODS A single-center, two-surgeon, 5-year retrospective review (2014 to 2019) was performed examining subjects who underwent abdominal wall reconstruction in the onlay plane with resorbable synthetic mesh or in the intraperitoneal plane with biologic mesh. A matched paired analysis was conducted. Data examining demographic characteristics, intraoperative variables, postoperative outcomes, and costs were analyzed. RESULTS Eighty-eight subjects (44 per group) were identified (median follow-up, 24.5 months). The mean age was 57.7 years, with a mean body mass index of 30.4 kg/m2. The average defect size was 292 ± 237 cm2, with most wounds being clean-contaminated (48.9 percent) and 55 percent having failed prior repair. Resorbable synthetic mesh onlay subjects were significantly less likely (4.5 percent) to experience recurrence compared to biologic intraperitoneal mesh subjects (22.7 percent; p < 0.026). In addition, mesh onlay suffered fewer postoperative surgical-site occurrences (18.2 percent versus 40.9 percent; p < 0.019) and required fewer procedural interventions (11.4 percent versus 36.4 percent; p < 0.011), and was also associated with significantly lower total costs ($16,658 ± $14,930) compared to biologic intraperitoneal mesh ($27,645 ± $16,864; p < 0.001). CONCLUSIONS Abdominal wall reconstruction remains an evolving field, with various techniques available for treatment. When faced with hernia repair, resorbable synthetic mesh in the onlay plane may be preferable to biologic mesh placed in the intraperitoneal plane because of lower long-term recurrence rates, surgical-site complications, and costs. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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4
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Patiniott P, Jacombs A, Kaul L, Hu H, Warner M, Klosterhalfen B, Karatassas A, Maddern G, Richter K. Are late hernia mesh complications linked to Staphylococci biofilms? Hernia 2022; 26:1293-1299. [PMID: 35286510 PMCID: PMC9525333 DOI: 10.1007/s10029-022-02583-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
Abstract
Purpose The purpose of this study was to investigate the link between bacterial biofilms and negative outcomes of hernia repair surgery. As biofilms are known to play a role in mesh-related infections, we investigated the presence of biofilms on hernia meshes, which had to be explanted due to mesh failure without showing signs of bacterial infection. Methods In this retrospective observational study, 20 paraffin-embedded tissue sections from explanted groin hernia meshes were analysed. Meshes have been removed due to chronic pain, hernia recurrence or mesh shrinkage. The presence and bacterial composition of biofilms were determined. First, specimens were stained with fluorescence in situ hybridisation (FISH) probes, specific for Staphylococcus aureus and coagulase-negative staphylococci, and visualised by confocal laser scanning microscopy. Second, DNA was extracted from tissue and identified by S. aureus and S. epidermidis specific PCR. Results Confocal microscopy showed evidence of bacterial biofilms on meshes in 15/20 (75.0%) samples, of which 3 were positive for S. aureus, 3 for coagulase-negative staphylococci and 9 for both species. PCR analysis identified biofilms in 17/20 (85.0%) samples, of which 4 were positive for S. aureus, 4 for S. epidermidis and 9 for both species. Combined results from FISH/microscopy and PCR identified staphylococci biofilms in 19/20 (95.0%) mesh samples. Only 1 (5.0%) mesh sample was negative for bacterial biofilm by both techniques. Conclusion Results suggest that staphylococci biofilms may be associated with hernia repair failure. A silent, undetected biofilm infection could contribute to mesh complications, chronic pain and exacerbation of disease.
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Affiliation(s)
- P Patiniott
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia
| | - A Jacombs
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - L Kaul
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Institute of Pharmaceutical Sciences, Department of Pharmaceutical Technology and Biopharmacy, University of Freiburg, Freiburg, Germany
| | - H Hu
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - M Warner
- Microbiology and Infectious Diseases Directorate, SA Pathology, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,Infectious Diseases Unit, Central Adelaide Local Health Network, Adelaide, Australia
| | - B Klosterhalfen
- MVZ für Histologie, Zytologie und Molekulare Diagnostik Düren GmbH, Düren, Germany
| | - A Karatassas
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - G Maddern
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - K Richter
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia. .,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia. .,Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia.
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5
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Jacombs ASW, Karatassas A, Klosterhalfen B, Richter K, Patiniott P, Hensman C. Biofilms and effective porosity of hernia mesh: are they silent assassins? Hernia 2019; 24:197-204. [DOI: 10.1007/s10029-019-02063-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/27/2019] [Indexed: 02/06/2023]
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Pérez-Tanoira R, Lévano-Linares C, Celdrán-Uriarte Á, Isea-Peña MC, De Molina MS, García-Vasquez C, Esteban-Moreno J. Use of an experimental model to evaluate infection resistance of meshes in abdominal wall surgery. J Surg Res 2016; 206:435-441. [PMID: 27884340 DOI: 10.1016/j.jss.2016.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/05/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Staphylococcal species are the most common organisms causing prosthetic mesh infections, however, infections due to rapidly growing mycobacteria are increasing. This study evaluates the resistance of biomaterial for abdominal wall prostheses against the development of postoperative infection in a rat model. MATERIAL AND METHODS In 75 rats, we intramuscularly implanted three different types of prostheses: (1) low-density polypropylene monofilament mesh (PMM), (2) high-density PMM, and (3) a composite prosthesis composed of low-density PMM and a nonporous hydrophilic film. Meshes were inoculated with a suspension containing 108 colony-forming units of Staphylococcus aureus, Staphylococcus epidermidis, Mycobacterium fortuitum, or Mycobacterium abscessus before wound closure. Animals were sacrificed on the eighth day postoperatively for clinical evaluation, and the implants were removed for bacteriologic analyses. RESULTS Prostheses infected with S aureus showed a higher bacterial viability, worse integration, and clinical outcome compared with infection by other bacteria. Composite prostheses showed a higher number of viable colonies of both M fortuitum and Staphylococcus spp., with poorer integration in host tissue. However, when the composite prosthesis was infected with M abscessus, a lower number of viable bacteria were isolated and a better integration was observed compared with infection by other bacteria. CONCLUSIONS Considering M abscessus, a smaller collagen-free contact surface shows better resistance to infection, however, depending on the type of bacteria, prostheses with a large surface, and covered with collagen shows reduced resistance to infection, worse integration, and worse clinical outcome.
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Affiliation(s)
- Ramón Pérez-Tanoira
- Department of Microbiology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - C Lévano-Linares
- Department of General Surgery, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Á Celdrán-Uriarte
- Department of General Surgery, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - M C Isea-Peña
- Department of Microbiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - C García-Vasquez
- Department of General Surgery, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - J Esteban-Moreno
- Department of Microbiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
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8
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Basir A, Gründeman P, Moll F, van Herwaarden J, Pasterkamp G, Nijland R. Adherence of Staphylococcus aureus to Dyneema Purity® Patches and to Clinically Used Cardiovascular Prostheses. PLoS One 2016; 11:e0162216. [PMID: 27583703 PMCID: PMC5008695 DOI: 10.1371/journal.pone.0162216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/18/2016] [Indexed: 11/19/2022] Open
Abstract
Various materials that are used for vascular and heart valve prostheses carry drawbacks: some require anticoagulant drugs or have moderate durability; others are not suitable for endovascular treatment. These prostheses are associated with bacterial infections. A material potentially suitable for prostheses is Dyneema Purity®, made of ultra-high-molecular-weight polyethylene. Dyneema Purity® fibers are very thin, flexible, resistant to fatigue and abrasion, and have high strength. S. aureus adherence to Dyneema Purity® was tested and compared with currently used cardiovascular prostheses. We compared adhesion of S. aureus to Dyneema Purity® (1 membrane-based and 1 yarn-composed patch) with 5 clinically used yarn-composed polyester and membrane-based expanded polytetrafluoroethylene patches. Patches were contaminated with S. aureus bacteria and bacterial adherence was quantified. S. aureus adherence was also visualized in flow conditions. Overall, bacterial adherence was higher on yarn-composed prosthesis materials, with a rough surface, than on the membrane-based materials, with a smooth surface. Adherence to Dyneema Purity® materials was non-inferior to the currently used materials. Therefore, patches of Dyneema Purity® might be attractive for use in cardiovascular applications such as catheter-based heart valves and endovascular prostheses by their good mechanical properties combined with their noninferiority regarding bacterial adhesion.
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Affiliation(s)
- Amir Basir
- Department of Experimental Cardiology, UMC Utrecht, Utrecht, the Netherlands
- * E-mail: (AB); (RN)
| | - Paul Gründeman
- Department of Experimental Cardiology, UMC Utrecht, Utrecht, the Netherlands
| | - Frans Moll
- Department of Vascular Surgery, UMC Utrecht, Utrecht, the Netherlands
| | | | - Gerard Pasterkamp
- Department of Experimental Cardiology, UMC Utrecht, Utrecht, the Netherlands
| | - Reindert Nijland
- Department of Medical Microbiology, UMC Utrecht, Utrecht, The Netherlands
- Laboratory of Phytopathology, Wageningen University, Wageningen, The Netherlands
- * E-mail: (AB); (RN)
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9
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Scott JR, Deeken CR, Martindale RG, Rosen MJ. Evaluation of a fully absorbable poly-4-hydroxybutyrate/absorbable barrier composite mesh in a porcine model of ventral hernia repair. Surg Endosc 2016; 30:3691-701. [PMID: 27369286 PMCID: PMC4992027 DOI: 10.1007/s00464-016-5057-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/15/2016] [Indexed: 01/31/2023]
Abstract
Background The objective of this study was to evaluate the mechanical and histological properties of a fully absorbable poly-4-hydroxybutyrate/absorbable barrier composite mesh (Phasix™ ST) compared to partially absorbable (Ventralight™ ST), fully absorbable (Phasix™), and biologically derived (Strattice™) meshes in a porcine model of ventral hernia repair. Methods Bilateral abdominal surgical defects were created in twenty-four Yucatan pigs, repaired with intraperitoneal (Phasix™ ST, Ventralight™ ST) or retromuscular (Phasix™, Strattice™) mesh, and evaluated at 12 and 24 weeks (n = 6 mesh/group/time point). Results Prior to implantation, Strattice™ demonstrated significantly higher (p < 0.001) strength (636.6 ± 192.1 N) compared to Ventralight™ ST (324.3 ± 37.1 N), Phasix™ ST (206.9 ± 11.3 N), and Phasix™ (200.6 ± 25.2 N). At 12 and 24 weeks, mesh/repair strength was significantly greater than NAW (p < 0.01 in all cases), and no significant changes in strength were observed for any meshes between 12 and 24 weeks (p > 0.05). Phasix™ mesh/repair strength was significantly greater than Strattice™ (p < 0.001) at 12 and 24 weeks, and Ventralight™ ST mesh/repair strength was significantly greater than Phasix™ ST mesh (p < 0.05) at 24 weeks. At 12 and 24 weeks, Phasix™ ST and Ventralight™ ST were associated with mild inflammation and minimal–mild fibrosis/neovascularization, with no significant differences between groups. At both time points, Phasix™ was associated with minimal–mild inflammation/fibrosis and mild neovascularization. Strattice™ was associated with minimal inflammation/fibrosis, with minimal neovascularization at 12 weeks, which increased to mild by 24 weeks. Strattice™ exhibited significantly less neovascularization than Phasix™ at 12 weeks and significantly greater inflammation at 24 weeks due to remodeling. Conclusions Phasix™ ST demonstrated mechanical and histological properties comparable to partially absorbable (Ventralight™ ST) and fully resorbable (Phasix™) meshes at 12 and 24 weeks in this model. Data also suggest that fully absorbable meshes with longer-term resorption profiles may provide improved mechanical and histological properties compared to biologically derived scaffolds.
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Affiliation(s)
- Jeffrey R Scott
- Department of Molecular Pharmacology, Physiology and Biotechnology, Brown University, 171 Meeting Street, Box G-B, Providence, RI, 02912, USA. .,C. R. Bard, Inc. (Davol), Warwick, RI, USA.
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10
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Majumder A, Scott JR, Novitsky YW. Evaluation of the Antimicrobial Efficacy of a Novel Rifampin/Minocycline-Coated, Noncrosslinked Porcine Acellular Dermal Matrix Compared With Uncoated Scaffolds for Soft Tissue Repair. Surg Innov 2016; 23:442-55. [PMID: 27354551 DOI: 10.1177/1553350616656280] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Despite meticulous aseptic technique and systemic antibiotics, bacterial colonization of mesh remains a critical issue in hernia repair. A novel minocycline/rifampin tyrosine-coated, noncrosslinked porcine acellular dermal matrix (XenMatrix AB) was developed to protect the device from microbial colonization for up to 7 days. The objective of this study was to evaluate the in vitro and in vivo antimicrobial efficacy of this device against clinically isolated methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli. Methods XenMatrix AB was compared with 5 existing uncoated soft tissue repair devices using in vitro methods of zone of inhibition (ZOI) and scanning electron microscopy (SEM) at 24 hours following inoculation with MRSA or E coli These devices were also evaluated at 7 days following dorsal implantation and inoculation with MRSA or E coli (60 male New Zealand white rabbits, n = 10 per group) for viable colony-forming units (CFU), abscess formation and histopathologic response, respectively. Results In vitro studies demonstrated a median ZOI of 36 mm for MRSA and 16 mm for E coli for XenMatrix AB, while all uncoated devices showed no inhibition of bacterial growth (0 mm). SEM also demonstrated no visual evidence of MRSA or E coli colonization on the surface of XenMatrix AB compared with colonization of all other uncoated devices. In vivo XenMatrix AB demonstrated complete inhibition of bacterial colonization, no abscess formation, and a reduced inflammatory response compared with uncoated devices. Conclusion We demonstrated that XenMatrix AB possesses potent in vitro and in vivo antimicrobial efficacy against clinically isolated MRSA and E coli compared with uncoated devices.
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Affiliation(s)
- Arnab Majumder
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Jeffrey R Scott
- Brown University, Providence, RI, USA C. R. Bard, Inc (Davol), Warwick, RI, USA
| | - Yuri W Novitsky
- University Hospitals Case Medical Center, Cleveland, OH, USA
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11
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Pérez-Köhler B, Bayon Y, Bellón JM. Mesh Infection and Hernia Repair: A Review. Surg Infect (Larchmt) 2015; 17:124-37. [PMID: 26654576 DOI: 10.1089/sur.2015.078] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The use of a prosthetic mesh to repair a tissue defect may produce a series of post-operative complications, among which infection is the most feared and one of the most devastating. When occurring, bacterial adherence and biofilm formation on the mesh surface affect the implant's tissue integration and host tissue regeneration, making preventive measures to control prosthetic infection a major goal of prosthetic mesh improvement. METHODS This article reviews the literature on the infection of prosthetic meshes used in hernia repair to describe the in vitro and in vivo models used to examine bacterial adherence and biofilm formation on the surface of different biomaterials. Also discussed are the prophylactic measures used to control implant infection ranging from meshes soaked in antibiotics to mesh coatings that release antimicrobial agents in a controlled manner. RESULTS Prosthetic architecture has a direct effect on bacterial adherence and biofilm formation. Absorbable synthetic materials are more prone to bacterial colonization than non-absorbable materials. The reported behavior of collagen biomeshes, also called xenografts, in a contaminated environment has been contradictory, and their use in this setting needs further clinical investigation. New prophylactic mesh designs include surface modifications with an anti-adhesive substance or pre-treatment with antibacterial agents or metal coatings. CONCLUSIONS The use of polymer coatings that slowly release non-antibiotic drugs seems to be a good strategy to prevent implant contamination and reduce the onset of resistant bacterial strains. Even though the prophylactic designs described in this review are mainly focused on hernia repair meshes, these strategies can be extrapolated to other implantable devices, regardless of their design, shape or dimension.
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Affiliation(s)
- Bárbara Pérez-Köhler
- 1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .,2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Yves Bayon
- 3 Covidien - Sofradim Production , Trévoux, France
| | - Juan Manuel Bellón
- 1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .,2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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12
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Pérez-Köhler B, García-Moreno F, Brune T, Pascual G, Bellón JM. Preclinical Bioassay of a Polypropylene Mesh for Hernia Repair Pretreated with Antibacterial Solutions of Chlorhexidine and Allicin: An In Vivo Study. PLoS One 2015; 10:e0142768. [PMID: 26556805 PMCID: PMC4640885 DOI: 10.1371/journal.pone.0142768] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/27/2015] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Prosthetic mesh infection constitutes one of the major complications following hernia repair. Antimicrobial, non-antibiotic biomaterials have the potential to reduce bacterial adhesion to the mesh surface and adjacent tissues while avoiding the development of novel antibiotic resistance. This study assesses the efficacy of presoaking reticular polypropylene meshes in chlorhexidine or a chlorhexidine and allicin combination (a natural antibacterial agent) for preventing bacterial infection in a short-time hernia-repair rabbit model. METHODS Partial hernia defects (5 x 2 cm) were created on the lateral right side of the abdominal wall of New Zealand White rabbits (n = 21). The defects were inoculated with 0.5 mL of a 106 CFU/mL Staphylococcus aureus ATCC25923 strain and repaired with a DualMesh Plus antimicrobial mesh or a Surgipro mesh presoaked in either chlorhexidine (0.05%) or allicin-chlorhexidine (900 μg/mL-0.05%). Fourteen days post-implant, mesh contraction was measured and tissue specimens were harvested to evaluate bacterial adhesion to the implant surface (via sonication, S. aureus immunolabeling), host-tissue incorporation (via staining, scanning electron microscopy) and macrophage response (via RAM-11 immunolabeling). RESULTS The polypropylene mesh showed improved tissue integration relative to the DualMesh Plus. Both the DualMesh Plus and the chlorhexidine-soaked polypropylene meshes exhibited high bacterial clearance, with the latter material showing lower bacterial yields. The implants from the allicin-chlorhexidine group displayed a neoformed tissue containing differently sized abscesses and living bacteria, as well as a diminished macrophage response. The allicin-chlorhexidine coated implants exhibited the highest contraction. CONCLUSIONS The presoaking of reticular polypropylene materials with a low concentration of chlorhexidine provides the mesh with antibacterial activity without disrupting tissue integration. Due to the similarities found with the antimicrobial DualMesh Plus material, the chlorhexidine concentration tested could be utilized as a prophylactic treatment to resist infection by prosthetic mesh during hernia repair.
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Affiliation(s)
- Bárbara Pérez-Köhler
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Francisca García-Moreno
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | | | - Gemma Pascual
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Juan Manuel Bellón
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- * E-mail:
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Pérez-Tanoira R, Isea-Peña MC, Celdrán A, García-Vasquez C, Esteban J. Bacterial adherence to different meshes used in abdominal surgery. Surg Infect (Larchmt) 2013; 15:90-3. [PMID: 24283764 DOI: 10.1089/sur.2013.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We studied the influence of morphology and type of material of abdominal wall prostheses in the avoidance of bacterial adhesion in acute and chronic mesh infections. METHODS Three different types of prostheses were compared: 1) High-density polypropylene monofilament mesh (PMM); 2) low-density PMM; and 3) prostheses composed of low-density polypropylene and a non-porous hydrophilic film (composite prostheses). Microbial adhesion tests were performed using reference strains of Staphylococcus aureus 15981, Staphylococcus epidermidis ATCC 35984, Mycobacterium abscessus DSM 44196, and Mycobacterium fortuitum ATCC 13756 using a protocol described previously. RESULTS Both Staphylococcus spp. and M. fortuitum strains showed lower adherence to PMM. Mycobacterium abscessus also exhibited lower adherence to composite prostheses. Both Mycobacterium spp. strains had lower adherence than Staphylococcus spp. strains for all materials except for low-density PMM. Mycobacterium fortuitum showed higher adherence to composite prostheses than M. abscessus, whereas the latter species had higher adherence to high-density PMM than M. fortuitum. CONCLUSION Depending on the type of bacteria, collagen-coated hydrophilic prostheses with a large surface increased bacterial adherence significantly. These differences should be taken into consideration when choosing a mesh graft, which limits infection in abdominal wall reconstruction.
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García-Pumarino R, Pascual G, Rodríguez M, Pérez-Köhler B, Bellón JM. Do collagen meshes offer any benefits over preclude® ePTFE implants in contaminated surgical fields? A comparativein vitroandin vivostudy. J Biomed Mater Res B Appl Biomater 2013; 102:366-75. [DOI: 10.1002/jbm.b.33015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/05/2013] [Accepted: 07/27/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Rubén García-Pumarino
- Department of Surgery; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine, Alcalá University; Ctra. Madrid-Barcelona Alcalá de Henares Madrid Spain
| | - Gemma Pascual
- Department of Medical Specialities; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine, Alcalá University; Ctra. Madrid-Barcelona Alcalá de Henares Madrid Spain
| | - Marta Rodríguez
- Department of Surgery; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine, Alcalá University; Ctra. Madrid-Barcelona Alcalá de Henares Madrid Spain
| | - Bárbara Pérez-Köhler
- Department of Medical Specialities; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine, Alcalá University; Ctra. Madrid-Barcelona Alcalá de Henares Madrid Spain
| | - Juan Manuel Bellón
- Department of Surgery; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine, Alcalá University; Ctra. Madrid-Barcelona Alcalá de Henares Madrid Spain
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Sanders D, Lambie J, Bond P, Moate R, Steer JA. An in vitro study assessing the effect of mesh morphology and suture fixation on bacterial adherence. Hernia 2013; 17:779-89. [PMID: 23780573 DOI: 10.1007/s10029-013-1124-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 06/08/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Prosthetic infections, although relatively uncommon in hernia surgery, are a source of considerable morbidity and cost. The aims of this experimental study were to assess the influence of the morphological properties of the mesh on bacterial adherence in vitro. The morphological properties assessed were the polymer type, filament type, filament diameter, mesh weight, mean pore size, and the addition of silver chlorhexidine and titanium coatings. In addition, the study assessed the effect on bacterial adherence of adding a commonly used suture to the mesh and compared adherence rates to self-gripping mesh that does not require suture fixation. METHODS Eight commercially sourced flat hernia meshes with different material characteristics were included in the study. These were Prolene(®) (Ethicon(®)), DualMesh(®) (Gore(®)), DualMesh(®) Plus (Gore(®)), Parietex™ ProGrip (Covidien™), TiMesh(®) Light (GfE Medical), Bard(®) Soft Mesh (Bard(®)), Vypro(®) (Ethicon(®)), and Omyra(®) (Braun(®)). Individual meshes were inoculated with Staphylococcus epidermidis and Staphylococcus aureus with a bacterial inoculum of 10(2) bacteria. To assess the effect of suture material on bacterial adhesion, a sterile piece of commonly used monofilament suture material (2.0 Prolene(®), ZB370 Ethicon(®)) was sutured to selected meshes (chosen to represent different commonly used polymers and/or the presence of an antibacterial coating). Inoculated meshes were incubated for 18 h in tryptone soy broth and then analysed using scanning electron microscopy. A previously validated method for enumeration of bacteria using automated stage movement electron microscopy was used for direct bacterial counting. The final fraction of the bacteria adherent to the mesh was compared between the meshes and for each morphological variable. One-way analysis of variance (ANOVA) was performed on the bacterial counts. Tukey's test was used to determine the difference between the different biomaterials in the event the ANOVA was significant. RESULTS Properties that significantly increased the mean bacterial adherence were the expanded polytetrafluoroethylene polymer (P < 0.001); multifilament meshes (P < 0.001); increased filament diameter (P < 0.001); increased mesh weight (P < 0.001); and smaller mean pore size (P < 0.001). In contrast, mesh coating with antibacterial silver chlorhexidine significantly reduced bacterial adhesion (S. epidermidis mean bacterial count 140.7 ± 19.1 SE with DualMesh(®) vs. 2.3 ± 1.2 SE with DualMesh(®) Plus, P < 0.001; S. aureus mean bacterial count 371.7 ± 22.7 SE with DualMesh(®) vs. 19.3 ± 4.7 SE with DualMesh(®) Plus, P = 0.002). The addition of 2.0 Prolene suture material significantly increased the mean number of adherent bacteria independent of the mesh polymer or mesh coating (P = 0.04 to <0.001). CONCLUSION The present study demonstrates the significant influence of the prosthetic load on bacterial adherence. In patients at increased risk of infection, low prosthetic load materials, i.e., lightweight meshes with large pores, may be beneficial. Furthermore self-fixing meshes, which avoid increasing the prosthetic load and antibacterial impregnated meshes, may have an advantage in this setting.
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Affiliation(s)
- D Sanders
- Peninsula College of Medicine and Dentistry, John Bull Building, Tamar Science Park, Plymouth, PL6 8BU, UK,
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Martin DP, Badhwar A, Shah DV, Rizk S, Eldridge SN, Gagne DH, Ganatra A, Darois RE, Williams SF, Tai HC, Scott JR. Characterization of poly-4-hydroxybutyrate mesh for hernia repair applications. J Surg Res 2013; 184:766-73. [PMID: 23582230 DOI: 10.1016/j.jss.2013.03.044] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Phasix mesh is a fully resorbable implant for soft tissue reconstruction made from knitted poly-4-hydroxybutyrate monofilament fibers. The objectives of this study were to characterize the in vitro and in vivo mechanical and resorption properties of Phasix mesh over time, and to assess the functional performance in a porcine model of abdominal hernia repair. MATERIALS AND METHODS We evaluated accelerated in vitro degradation of Phasix mesh in 3 mol/L HCl through 120 h incubation. We also evaluated functional performance after repair of a surgically created abdominal hernia defect in a porcine model through 72 wk. Mechanical and molecular weight (MW) properties were fully characterized in both studies over time. RESULTS Phasix mesh demonstrated a significant reduction in mechanical strength and MW over 120 h in the accelerated degradation in vitro test. In vivo, the Phasix mesh repair demonstrated 80%, 65%, 58%, 37%, and 18% greater strength, compared with native abdominal wall at 8, 16, 32, and 48 wk post-implantation, respectively, and comparable repair strength at 72 wk post-implantation despite a significant reduction in mesh MW over time. CONCLUSIONS Both in vitro and in vivo data suggest that Phasix mesh provides a durable scaffold for mechanical reinforcement of soft tissue. Furthermore, a Phasix mesh surgical defect repair in a large animal model demonstrated successful transfer of load bearing from the mesh to the repaired abdominal wall, thereby successfully returning the mechanical properties of repaired host tissue to its native state over an extended time period.
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Does presoaking synthetic mesh in antibiotic solution reduce mesh infections? An experimental study. J Gastrointest Surg 2013; 17:562-8. [PMID: 23212529 DOI: 10.1007/s11605-012-2099-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/19/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prosthetic mesh infection is one of the most challenging complications after hernia repair. We evaluate the efficacy of soaking mesh in antibiotics to prevent prosthetic infection in an animal model of clean-contaminated ventral hernia repair (VHR). MATERIAL AND METHODS Rats underwent an acute VHR with one of four synthetic meshes (composite multifilament polyester (Parietex PCO), multifilament polyester (Parietex TET), composite monofilament polypropylene (Ventralight), or monofilament polypropylene (SoftMesh)). Prior to implantation, mesh was soaked in saline or 10 mg/ml of vancomycin for 15 min. Following implantation, meshes were contaminated with 10(4) CFU of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Thirty days after implantation, mesh samples were cultured and evaluated under scanning electron microscope for biofilm formation. RESULTS Presoaking meshes significantly improves bacterial clearance in composite meshes and multifilament polyester mesh. MRSA clearance was as follows for all meshes (saline-soaked vs. vanco-soaked): Parietex PCO (0 vs. 56 %, p = 0.006), Parietex TET (0 vs. 50 %, p = 0.01), Ventralight (20 vs. 78 %, p = 0.012), and SoftMesh (70 vs. 80 %, p = 0.6). MRSA biofilm formation was consistent with bacterial growth. CONCLUSION Presoaking multifilament and composite mesh in vancomycin solution reduces MRSA bacterial growth. Its implementation may reduce the risk of mesh infection in clean-contaminated cases, although further investigation with human trials should be performed.
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Hicks CW, Blatnik JA, Krpata DM, Novitsky YW, Rosen MJ. 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 2013; 18:65-70. [PMID: 23329253 DOI: 10.1007/s10029-012-1035-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 12/27/2012] [Indexed: 11/26/2022]
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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Affiliation(s)
- C W Hicks
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA,
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Sanders DL, Bond P, Moate R, Steer JA. Design and validation of a novel quantitative method for rapid bacterial enumeration using programmed stage movement scanning electron microscopy. J Microbiol Methods 2012; 91:544-50. [DOI: 10.1016/j.mimet.2012.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/16/2012] [Accepted: 09/21/2012] [Indexed: 10/27/2022]
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Stoodley P, Sidhu S, Nistico L, Mather M, Boucek A, Hall-Stoodley L, Kathju S. Kinetics and morphology of polymicrobial biofilm formation on polypropylene mesh. ACTA ACUST UNITED AC 2012; 65:283-90. [DOI: 10.1111/j.1574-695x.2012.00948.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/13/2012] [Accepted: 02/16/2012] [Indexed: 11/30/2022]
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Matosziuk LM, Harney AS, Macrenaris KW, Meade TJ. Synthesis, Characterization, and in vitro Testing of a Bacteria-Targeted MR Contrast Agent. Eur J Inorg Chem 2012; 2012:2099-2107. [PMID: 23626484 PMCID: PMC3634600 DOI: 10.1002/ejic.201101362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Indexed: 12/29/2022]
Abstract
A bacteria-targeted MR contrast agent, Zn-1, consisting of two Zn-dipicolylamine (Zn-dpa) groups conjugated to a GdIII chelate has been synthesized and characterized. In vitro studies with S. aureus and E. coli show that Zn-1 exhibits a significant improvement in bacteria labeling efficiency vs. control. Studies with a structural analogue, Zn-2, indicate that removal of one Zn-dpa moiety dramatically reduces the agent's affinity for bacteria. The ability of Zn-1 to significantly reduce the T1 of labeled vs. unlabeled bacteria, resulting in enhanced MR image contrast, demonstrates its potential for visualizing bacterial infections in vivo.
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Affiliation(s)
- Lauren M Matosziuk
- Departments of Chemistry, Molecular Biosciences, Neurobiology, Biomedical Engineering, and Radiology, Northwestern University, 2145 Sheridan Rd., Evanston, IL 60208, USA
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Vassiliou I, Ioannis V, Tympa A, Aliki T, Theodosopoulos T, Theodosios T, Nastos C, Constantinos N, Arkadopoulos N, Nikolaos A, Dafnios N, Nikolaos D, Fragulidis G, Georgios F, Kouskouni E, Evangelia K, Smyrniotis V, Vassilios S. Late polypropylene mesh susceptibility to infection during intra-abdominal sepsis. J INVEST SURG 2011; 24:199-204. [PMID: 21867388 DOI: 10.3109/08941939.2011.584655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the susceptibility of high-density polypropylene mesh to contamination, 1 year after experimental hernia repair. METHODS Wistar rats were randomized into two groups: one experimental group (n = 20) and another control group (n = 10). Mesh hernia repair was performed with intra-abdominal (group I, n = 10) or subcutaneous (group II, n = 10) implantation of grafts. The three groups were exposed to an intra-abdominal E. coli administration after 1 year of operation. After 24 hr, the meshes and peritoneum were sampled from the experimental and control groups, respectively, in order to assess bacterial inoculation. Immunoreaction to E. coli inoculation was also evaluated after 24 hr by measuring serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels. RESULTS Bacteriological analysis revealed increased contamination in groups I and II when compared with the control group (p = .001 and .007, respectively). IL-6 levels were increased in both groups I and II compared with the control group, 24 hr after E. coli injection (p = .034 and .022, respectively), while there was no statistically significant difference between groups concerning the concentration of CRP. CONCLUSIONS Polypropylene mesh is vulnerable to bacterial inoculation during intra-abdominal sepsis 1 year after mesh placement.
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Affiliation(s)
- Ioannis Vassiliou
- Second Department of Surgery, Experimental Surgery Unit, School of Medicine, Aretaieion University Hospital, University of Athens, Greece
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Complex Hernia Repair Using Component Separation Technique Paired with Intraperitoneal Acellular Porcine Dermis and Synthetic Mesh Overlay. Ann Plast Surg 2011; 66:280-4. [DOI: 10.1097/sap.0b013e3181e9449d] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaito C, Saito Y, Nagano G, Ikuo M, Omae Y, Hanada Y, Han X, Kuwahara-Arai K, Hishinuma T, Baba T, Ito T, Hiramatsu K, Sekimizu K. Transcription and translation products of the cytolysin gene psm-mec on the mobile genetic element SCCmec regulate Staphylococcus aureus virulence. PLoS Pathog 2011; 7:e1001267. [PMID: 21304931 PMCID: PMC3033363 DOI: 10.1371/journal.ppat.1001267] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 12/30/2010] [Indexed: 11/18/2022] Open
Abstract
The F region downstream of the mecI gene in the SCCmec element in hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) contains two bidirectionally overlapping open reading frames (ORFs), the fudoh ORF and the psm-mec ORF. The psm-mec ORF encodes a cytolysin, phenol-soluble modulin (PSM)-mec. Transformation of the F region into the Newman strain, which is a methicillin-sensitive S. aureus (MSSA) strain, or into the MW2 (USA400) and FRP3757 (USA300) strains, which are community-acquired MRSA (CA-MRSA) strains that lack the F region, attenuated their virulence in a mouse systemic infection model. Introducing the F region to these strains suppressed colony-spreading activity and PSMα production, and promoted biofilm formation. By producing mutations into the psm-mec ORF, we revealed that (i) both the transcription and translation products of the psm-mec ORF suppressed colony-spreading activity and promoted biofilm formation; and (ii) the transcription product of the psm-mec ORF, but not its translation product, decreased PSMα production. These findings suggest that both the psm-mec transcript, acting as a regulatory RNA, and the PSM-mec protein encoded by the gene on the mobile genetic element SCCmec regulate the virulence of Staphylococcus aureus.
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Affiliation(s)
- Chikara Kaito
- Laboratory of Microbiology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Yuki Saito
- Laboratory of Microbiology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Gentaro Nagano
- Laboratory of Microbiology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Mariko Ikuo
- Laboratory of Microbiology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Yosuke Omae
- Laboratory of Microbiology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Yuichi Hanada
- Laboratory of Microbiology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Xiao Han
- Department of Infection Control Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kyoko Kuwahara-Arai
- Department of Infection Control Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Tomomi Hishinuma
- Department of Infection Control Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Tadashi Baba
- Department of Infection Control Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Teruyo Ito
- Department of Infection Control Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Keiichi Hiramatsu
- Department of Infection Control Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhisa Sekimizu
- Laboratory of Microbiology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
- * E-mail: .
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Halaweish I, Harth K, Broome AM, Voskerician G, Jacobs MR, Rosen MJ. 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) 2011; 11:449-54. [PMID: 20815759 DOI: 10.1089/sur.2009.048] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mesh infection complicating hernia repair is a major cause of patient morbidity and results in substantial healthcare expenditures. The various constructs of prosthetic mesh may alter the ability of bacteria to attach and form a biofilm. Few data exist evaluating biofilm formation. Using the Maestro in-Vivo Imaging System (CRi, Inc., Woburn, MA) to detect green fluorescent protein (GFP)-expressing Staphylococcus aureus, we studied the ability of synthetic mesh to withstand bacterial biofilm formation in an in vitro model. METHODS We included four meshes: Polypropylene (PP), polypropylene/expanded PTFE (PX), compressed PTFE (cPTFE), and polyester/polyethylene glycol and collagen hydrogel (PE). Five samples of each mesh were exposed to GFP-expressing S. aureus for 18 h at 37°C. Next, green fluorescence was measured using the Maestro Imaging System, with the results expressed in relative fluorescence units (RFU), subtracting the fluorescence of uninfected mesh (control). Each mesh subsequently underwent sonication and quantitative culture of the released bacteria, with the results expressed in colony-forming units (CFU). Analysis of variance was performed to compare the mean values for the different meshes. RESULTS There was a statistically significant difference in bacterial fluorescence for the four meshes: PE (49.9 ± 25.5 [standard deviation] RFU), PX (30.8 ± 9.4 RFU), cPTFE (10.1 ± 4.0 RFU), and PP (5.8 ± 7.5 RFU)(p = 0.001). Bacterial counts also were significantly different: PE (2.2 × 10(8) CFU), PX (8.6 × 10(7) CFU), cPTFE (3.7 × 10(7) CFU), and PP (9.1 × 10(7) CFU)(p < 0.001). CONCLUSION Using novel imaging technology, this study documented significantly different amounts of S. aureus biofilm formation and proliferation on different mesh constructs, with good agreement between imaging and culture results. A multifilament woven mesh (PE) had the highest degree of biofilm formation. These findings are being evaluated in a clinical infection model.
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Affiliation(s)
- Ihab Halaweish
- Case Western Reserve School of Medicine, Cleveland, OH, USA
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26
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Searching for the best polypropylene mesh to be used in bowel contamination. Hernia 2010; 15:173-9. [PMID: 21152940 DOI: 10.1007/s10029-010-0762-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 11/21/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE There is still some concern about the use of polypropylene in case of infection or contamination. The biocompatibility of the recently introduced light-weight polypropylene meshes seems to be promising. This experimental study was designed to evaluate three different weights and pore sizes of polypropylene meshes in a contamination model. METHODS Thirty rabbits were operated through a pararectal incision. The abdomen, wound and mesh were contaminated with faecal fluid aspirated from the appendix. Groups of ten animals were studied according to three different pore sizes of polypropylene mesh implanted as an inlay technique: very large pore, large pore and medium pore. Five animals of each group were sacrificed on days 21 and 90. Incisional surgical site infection and microbiologic cultures on the 21st and 90th days were the main outcome measures. Tissue integration, shrinkage and biomechanical properties were also tested. RESULTS Two rabbits died on day 1. There were six incisional surgical site infections (21.4%). Four animals had positive cultures with no macroscopic infection. None of the surviving rabbits with very large pore mesh had clinical infection or positive microbiologic cultures. Very large pore meshes shrank significantly more on day 21. There were no differences in the tensiometric test results. CONCLUSIONS In our experimental model, low-weight, very large pore polypropylene meshes seem to be the best polypropylene mesh in case of intestinal contamination. These results encourage clinical investigation on the use of low-weight, very large pore polypropylene meshes in the treatment and prevention of hernias in the presence of clean-contaminated or contaminated fields.
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