title: [Mesh infection in inguinal hernioplasty by Streptococcus dysgalactiae subspecies equisimilis. Case report and review of the literature].
abstract: BACKGROUND
  Mesh infection in inguinal herniography is usually caused by Staphilococcus aureus and Staphilcoccus epidermidis. Generally it obliges to prosthesis removal with hernia relapse and increase of social costs for the prolongation of hospitalization.
  
  
  METHODS
  A 60-year-old woman, obese, undergone 4 months before to left inguinal prosthetic herniorrhaphy complicated by infection of the surgical site which didn't require the explantation of the mesh, although determining an early hernia relapse. She is submitted by the authors to a surgical intervention for left groin hernia relapse with placement of a polypropylene monofilament fixed with prolene. Six hours after the operation she shows systemic symptoms and local signs of prosthesis infection. Cultural examination of the surgical wound secretion allows the identification of Streptococcus dysgalactiae subspecies equisimilis (SDSE). A therapy with Amoxicillin-Clavulanic Acid and Levofloxacine leads to resolution, in 10 weeks, of the infection.
  
  
  CONCLUSIONS
  In our case the infection of the new mesh, appearing prematurely, has been probably favoured by obesity and operative time longer than 3 hours. Conservative treatment has been fulfilled by success for the elevated sensitivity of the SDSE bacterium to penicillin and fluoroquinolones.
  
  
  CONCLUSIONS
  Recent epidemiologic studies have demonstrated an increase of infections caused by SDSE, which will probably gain clinical relevance in the next future relatively to surgical prosthetic hernioplasty. In all cases of infection the authors suggest cultural isolation of the casual germ and the execution of the antibiogram because the conservative medical treatment can avoid mesh removal with consequent elevated risk of hernia relapse.
authors.affiliation: Sapienza Università di Roma, polo pontino, Ospedale A Fiorini Terracina, AUSL Latina UOC Chirurgia Universitaria.
authors.forename: E
authors.initials: E
authors.lastname: Spaziani
authors.forename: A
authors.initials: A
authors.lastname: Di Filippo
authors.forename: M
authors.initials: M
authors.lastname: Picchio
authors.forename: M
authors.initials: M
authors.lastname: Maragoni
authors.forename: M
authors.initials: M
authors.lastname: Briganti
authors.forename: F
authors.initials: F
authors.lastname: Ceci
authors.forename: E
authors.initials: E
authors.lastname: Greco
authors.forename: F
authors.initials: F
authors.lastname: De Angelis
authors.forename: G
authors.initials: G
authors.lastname: Pattaro
authors.forename: A
authors.initials: A
authors.lastname: Maturo
authors.forename: A
authors.initials: A
authors.lastname: Martellucci
authors.forename: F
authors.initials: F
authors.lastname: Stagnitti
mesh_terms: D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006552:Hernia, Inguinal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D015242:Ofloxacin / Q000627:therapeutic use; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000382:microbiology; D013290:Streptococcal Infections / Q000209:etiology* / Q000382:microbiology; D013526:Surgical Mesh / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D015242:Ofloxacin