gms | German Medical Science

Background: Mesh infection is a severe complication after incisional hernia repair and occurs in 1% to 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.

Materials and methods: Two different meshes (polyester multifilament and large pore polypropylene) were incubated with increasing amounts of three different S. 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 24h after implantation of gemtamicin-impregnated multifilament meshes in 19 patients. This procedure is routine since many years in our department and the serum levels of gentamicin are monitored as a means of patient safety and quality control.

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 6h after implantation of the gentamicin impregnated meshes were below the through-level (range: 0.4-2.9mg/l, mean: 1.2±0.7 mg/l). After 24h the gentamicin serum levels in all patients had declined 90% to 65% of the 6h values.

Conclusion: 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 is very low, without reaching therapeutic concentrations.