title: Direct demonstration of bacterial biofilms on prosthetic mesh after ventral herniorrhaphy.
abstract: BACKGROUND
  Prosthetic mesh is employed routinely in the treatment of ventral and parastomal hernias, but its use can lead to major complications, including infection, extrusion, and fistula. Bacterial biofilms have been posited to play a role in mesh-related infection, but although bacteria have been noted to form biofilms on mesh surfaces in vitro, they have never been visualized directly in biofilms on mesh recovered from patients experiencing infectious complications.
  
  
  METHODS
  Five patients who developed complications after ventral hernia repair with prosthetic mesh were operated on again. Explanted mesh was examined for biofilm with confocal laser scanning microscopy (CLSM) and fluorescence in situ hybridization (FISH). In two cases, a novel molecular assay (the Ibis T5000) was used to characterize the biofilm-forming bacteria.
  
  
  RESULTS
  The CLSM examination demonstrated adherent biofilms on mesh surfaces in all five patients. Biofilms also were noted on investing fibrous tissue. The FISH study was able to discriminate between bacterial species in polymicrobial biofilms. In two patients the Ibis T5000 detected more species of constituent biofilm bacteria than did standard culture. Removal of the mesh and reconstruction with autologous tissues or biologic materials resolved the presenting complaints in all cases.
  
  
  CONCLUSIONS
  Bacterial biofilms should be considered an important contributor to the pathology and complications associated with prosthetic mesh implanted in the abdominal wall. If biofilms are present, complete removal of the mesh and repair of the resulting defect without alloplastic materials is an effective intervention.
authors.affiliation: 1 Department of Plastic Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kathju
authors.forename: Laura
authors.initials: L
authors.lastname: Nistico
authors.forename: Rachael
authors.initials: R
authors.lastname: Melton-Kreft
authors.forename: Leslie-Ann
authors.initials: LA
authors.lastname: Lasko
authors.forename: Paul
authors.initials: P
authors.lastname: Stoodley
mesh_terms: D000818:Animals; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D018407:Bacterial Physiological Phenomena; D018441:Biofilms / Q000254:growth & development*; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D013526:Surgical Mesh / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000382:microbiology*