Microbiological epidemiology and antibiotic susceptibility of infected meshes after prosthetic abdominal wall repair

M Siebert; C Lhomme; E Carbonnelle; C Trésallet; A Kolakowska; F Jaureguy

doi:10.1016/j.jviscsurg.2023.02.007

Microbiological epidemiology and antibiotic susceptibility of infected meshes after prosthetic abdominal wall repair

J Visc Surg. 2023 Apr;160(2):85-89. doi: 10.1016/j.jviscsurg.2023.02.007. Epub 2023 Mar 17.

Authors

M Siebert¹, C Lhomme², E Carbonnelle³, C Trésallet², A Kolakowska⁴, F Jaureguy⁵

Affiliations

¹ Digestive, bariatric and endocrine surgery unit, hôpital Avicenne, AP-HP, Bobigny, France. Electronic address: siebertmatthieu@gmail.com.
² Digestive, bariatric and endocrine surgery unit, hôpital Avicenne, AP-HP, Bobigny, France.
³ Clinical microbiology department, groupe hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France.
⁴ Infectious and tropical diseases unit, groupe hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France.
⁵ Clinical microbiology department, groupe hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France; Infection antimicrobials modelling evolution (IAME), UMR 1137, université Paris 13, Sorbonne Paris Cité, France.

PMID: 36935232
DOI: 10.1016/j.jviscsurg.2023.02.007

Abstract

Introduction: Infectious complications of parietal mesh after prosthetic abdominal wall repair are rare. Their management is complex. Furthermore, the emergence of bacterial resistance, the presence of a foreign material, the need to continue an extended antibiotic therapy, and the choice of an appropriate treatment are crucial. The objective of this study is to access the microbiological epidemiology of infected parietal meshes in order to optimize the empirical antibiotic therapy.

Methods: Between January 2016 and December 2021, a monocentric and retrospective study was performed in patients hospitalized for infected parietal meshes at Avicenne hospital, in Paris area. Clinical and microbiological data such as antibiotic susceptibility were collected.

Results: Twenty-six patients with infected parietal meshes have been hospitalized during this period. Meshes were in preaponevrotic positions (n=10; 38%), retromuscular (n=6; 23%) and intraperitoneal (n=10; 38%). Among the 22 (84.6%) documented cases of infections, 17 (77.3%) were polymicrobial. A total of 54 bacteria were isolated, 48 of which had an antibiogram available. The most frequently isolated bacteria were: Enterobacterales (n=19), Enterococcus spp. (n=11) and Staphylococcus aureus (n=6), whereas anaerobes were poorly isolated (n=3). Concerning these isolated bacteria, amoxicillin-clavulanic acid, metronidazole-associated cefotaxime, piperacillin-tazobactam and meropenem were susceptible in 45.5%, 68.2%, 63.6%, 77.2%, of cases, respectively.

Conclusion: This work highlights that infections of abdominal parietal meshes may be polymicrobial and the association amoxicillin-clavulanic acid cannot be used as a probabilist antibiotic therapy because of the high resistance rate in isolated bacteria. The association piperacillin-tazobactam appears to be a more adapted empirical treatment to preserve carbapenems, a broad-spectrum antibiotic class.

Keywords: Antibiotic susceptibility; Antibiotic therapy; Carbapenem; Infection; Parietal meshes.

MeSH terms

Abdominal Wall*
Amoxicillin-Potassium Clavulanate Combination*
Anti-Bacterial Agents / therapeutic use
Humans
Piperacillin, Tazobactam Drug Combination
Retrospective Studies

Substances

Amoxicillin-Potassium Clavulanate Combination
Anti-Bacterial Agents
Piperacillin, Tazobactam Drug Combination