title: Does presoaking synthetic mesh in antibiotic solution reduce mesh infections? An experimental study.
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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106-5047, USA.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Sadava
authors.forename: David M
authors.initials: DM
authors.lastname: Krpata
authors.forename: Yue
authors.initials: Y
authors.lastname: Gao
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D018441:Biofilms / Q000187:drug effects*; D006555:Hernia, Ventral / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D011091:Polyesters; D011126:Polypropylenes; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000517:prevention & control*; D051381:Rats; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control; D013526:Surgical Mesh / Q000009:adverse effects* / Q000382:microbiology; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D011091:Polyesters; D011126:Polypropylenes; D014640:Vancomycin