title: Mesh Infection and Hernia Repair: A Review.
abstract: BACKGROUND
  The use of a prosthetic mesh to repair a tissue defect may produce a series of post-operative complications, among which infection is the most feared and one of the most devastating. When occurring, bacterial adherence and biofilm formation on the mesh surface affect the implant's tissue integration and host tissue regeneration, making preventive measures to control prosthetic infection a major goal of prosthetic mesh improvement.
  
  
  METHODS
  This article reviews the literature on the infection of prosthetic meshes used in hernia repair to describe the in vitro and in vivo models used to examine bacterial adherence and biofilm formation on the surface of different biomaterials. Also discussed are the prophylactic measures used to control implant infection ranging from meshes soaked in antibiotics to mesh coatings that release antimicrobial agents in a controlled manner.
  
  
  RESULTS
  Prosthetic architecture has a direct effect on bacterial adherence and biofilm formation. Absorbable synthetic materials are more prone to bacterial colonization than non-absorbable materials. The reported behavior of collagen biomeshes, also called xenografts, in a contaminated environment has been contradictory, and their use in this setting needs further clinical investigation. New prophylactic mesh designs include surface modifications with an anti-adhesive substance or pre-treatment with antibacterial agents or metal coatings.
  
  
  CONCLUSIONS
  The use of polymer coatings that slowly release non-antibiotic drugs seems to be a good strategy to prevent implant contamination and reduce the onset of resistant bacterial strains. Even though the prophylactic designs described in this review are mainly focused on hernia repair meshes, these strategies can be extrapolated to other implantable devices, regardless of their design, shape or dimension.
authors.affiliation: 1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .|2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain .
authors.forename: Bárbara
authors.initials: B
authors.lastname: Pérez-Köhler
authors.affiliation: 3 Covidien - Sofradim Production , Trévoux, France .
authors.forename: Yves
authors.initials: Y
authors.lastname: Bayon
authors.affiliation: 1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .|2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain .
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Bellón
mesh_terms: D001422:Bacterial Adhesion; D018407:Bacterial Physiological Phenomena; D018441:Biofilms / Q000254:growth & development; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D013526:Surgical Mesh / Q000009:adverse effects* / Q000382:microbiology