title: 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.
abstract: OBJECTIVE
  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.
authors: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA, hicksc@post.harvard.edu.
authors: C W
authors: CW
authors: Hicks
authors: J A
authors: JA
authors: Blatnik
authors: D M
authors: DM
authors: Krpata
authors: Y W
authors: YW
authors: Novitsky
authors: M J
authors: MJ
authors: Rosen
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D000075202:Contraindications; D003646:Debridement; D020878:Device Removal; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010359:Patient Readmission; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004318:Doxycycline