title: The addition of lysostaphin dramatically improves survival, protects porcine biomesh from infection, and improves graft tensile shear strength.
abstract: BACKGROUND
  Lysostaphin (LS), a naturally occurring Staphylococcal endopeptidase, has the ability to penetrate biofilm, and has been identified as a potential antimicrobial to prevent mesh infection. The goals of this study were to determine if LS adhered to porcine mesh (PM) can impact host survival, reduce the risk of long-term PM infection, and to analyze lysostaphin bound PM (LS-PM) mesh-fascial interface in an infected field.
  
  
  METHODS
  Abdominal onlay PMs measuring 3×3 cm were implanted in select groups of rats (n=75). Group assignments were based on bacterial inoculum and presence of LS on mesh. Explantation occurred at 60 d. Bacterial growth and mesh-fascial interface tensile strength were analyzed. Standard statistical analysis was performed.
  
  
  RESULTS
  Only one out of 30 rats with bacterial inoculum not treated with LS survived. All 30 LS treated rats survived and had normal appearing mesh, including 20 rats with a bacterial inoculum (10(6) and 10(8) CFU). Mean tensile strength for controls and LS and no inoculum samples was 3.47±0.86 N versus 5.0±1.0 N (P=0.008). LS groups inoculated with 10(6) and 10(8) CFU exhibited mean tensile strengths of 4.9±1.5 N and 6.7±1.6 N, respectively (P=0.019 and P<0.001 compared with controls).
  
  
  CONCLUSIONS
  Rats inoculated with S. aureus and not treated with LS had a mortality of 97%. By comparison, LS treated animals completely cleared S. aureus when challenged with bacterial concentrations of 1×10(6) and 1×10(8) with maintenance of mesh integrity at 60 d. These findings strongly suggest the clinical use of LS-treated porcine mesh in contaminated fields may translate into more durable hernia repair.
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, Charlotte, North Carolina 28204, USA.
authors.forename: Igor
authors.initials: I
authors.lastname: Belyansky
authors.forename: Victor B
authors.initials: VB
authors.lastname: Tsirline
authors.forename: Terri R
authors.initials: TR
authors.lastname: Martin
authors.forename: David A
authors.initials: DA
authors.lastname: Klima
authors.forename: Jessica
authors.initials: J
authors.lastname: Heath
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.forename: Rohan
authors.initials: R
authors.lastname: Satishkumar
authors.forename: Alexey
authors.initials: A
authors.lastname: Vertegel
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000818:Animals; D000891:Anti-Infective Agents, Local / Q000494:pharmacology; D001672:Biocompatible Materials / Q000494:pharmacology; D000071938:Fasciotomy; D046449:Hernia, Abdominal / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008248:Lysostaphin / Q000494:pharmacology*; D008297:Male; D051381:Rats; D011917:Rats, Inbred Lew; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000401:mortality / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects*; D013526:Surgical Mesh / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D013552:Swine; D013718:Tensile Strength
chemical_list: D000891:Anti-Infective Agents, Local; D001672:Biocompatible Materials; D008248:Lysostaphin