title: Gentamicin for prevention of intraoperative mesh contamination: demonstration of high bactericide effect (in vitro) and low systemic bioavailability (in vivo).
abstract: BACKGROUND
  Mesh infection is a severe complication after incisional hernia repair and occurs in 1-3 % of all open mesh implantations. For this reason, topical antimicrobial agent applied directly to the mesh is often used procedure. So far, however, this procedure lacks a scientific basis.
  
  
  METHODS
  Two different meshes (Parietex™, Covidien; Ultrapro™, Ethicon Johnson & Johnson) were incubated with increasing amounts of three different Staphylococcus aureus strains (ATCC 25923; Mu50; ST239) with or without gentamicin and growth ability were determined in vitro. To further address the question of the systemic impact of topic gentamicin, serum levels were analyzed 6 and 24 h after implantation of gentamicin-impregnated multifilament meshes in 19 patients.
  
  
  RESULTS
  None of the gentamicin-impregnated meshes showed any bacterial growth in vitro. This effect was independent of the mesh type for all the tested S. aureus strains. In the clinical setting, serum gentamicin levels 6 h after implantation of the gentamicin-impregnated meshes were below the through-level (range 0.4-2.9 mg/l, mean 1.2 ± 0.7 mg/l). After 24 h the gentamicin serum levels in all patients had declined 90-65 % of the 6 h values.
  
  
  CONCLUSIONS
  Local application of gentamicin to meshes can completely prevent the growth of even gentamicin-resistant S. aureus strains in vitro. The systemic relevance of gentamicin in the clinical controls showed to be very low, without reaching therapeutic concentrations.
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery (Department of Surgery I), University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Wiegering
authors.forename: B
authors.initials: B
authors.lastname: Sinha
authors.forename: L
authors.initials: L
authors.lastname: Spor
authors.forename: U
authors.initials: U
authors.lastname: Klinge
authors.forename: U
authors.initials: U
authors.lastname: Steger
authors.forename: C T
authors.initials: CT
authors.lastname: Germer
authors.forename: U A
authors.initials: UA
authors.lastname: Dietz
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood; D016903:Drug Monitoring; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000097:blood; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000517:prevention & control; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development; D013526:Surgical Mesh / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins
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