Gentamicin supplementation of polyvinylidenfluoride mesh materials for infection prophylaxis
Introduction
Mesh repair of abdominal wall hernias has become an integral part of general surgery, currently representing the standard procedure in recurrent or incisional abdominal wall hernia repair [1]. Although the use of mesh material has lead to several advantages such as the reduction of recurrence rates, their implantation is associated with significantly increased infection rates, as reported for incisional hernia, when compared to primary tissue repair [2], [3], [4], [5]. Furthermore, in the event of incarcerated or strangulated hernias and other potentially contaminated fields, their implacement remains controversial [6]. Overall a bacterial colonization in about 40% of all implants has been detected [2].
Whereas data concerning the efficacy of systemic antibiotic prophylaxis remains controversial [5], [7], [8], the application of local antibiotics has been described as safe and effective for hernia repair [9], [10]. Musella et al. [10] used a gentamicin-treated collagen tampon placed in front of the mesh, Lazorthes et al. [9] administered a single injection of cefamandole at the operative site during local anaesthesia. Both studies describe a significantly reduced postoperative infection rate when compared to control groups.
While in orthopaedic and vascular surgery antibiotic-coated materials are routinely used for infection prophylaxis for decades [11], [12], [13], [14] , no data are available on the spatial and temporal release of antibiotic agents with mesh materials.
As more than one million mesh implants are used per year globally, improvement of the materials to minimize infection would be beneficial. The aim of the present study was to determine the in vitro efficacy and in vivo biocompatibility of an antibiotic polyvinylidenfluoride (PVDF) mesh material using acrylic acid grafting and subsequent gentamicin binding.
Section snippets
Mesh modifications
The basic polymer investigated was polyvinylidenfluoride (PVDF), which is commonly used for mesh construction (Fig. 1, FEG Textiltechnik, Aachen, Germany). Plasma-induced graft polymerization was used to modify the surface chemistry and morphology of the PVDF mesh samples [15]. Immediately after treatment, oxygen was introduced into the chamber to generate hydroperoxide as well as other functional groups on the sample surface (German Wool Research Institute, RWTH Aachen, Germany). Thereafter,
Agar diffusion test
After 24 h the gentamicin supplemented PVDF mesh (PVDF+PAAc+Gentamicin) was found to have an antimicrobial effect (Fig. 2). Except for the gentamicin resistant E. coli strain none of the bacteria tested were found to show any signs of growth at the area of mesh placement on the agar plate. The pure PVDF mesh as well as the polyacrylic acid grafted mesh (PVDF+PAAc) showed no antimicrobial effect and a total overgrowth of bacteria after incubation. Diameters of the inhibition zones are given in
Discussion
Staphylococcus aureus as well as Staphylococcus epidermidis are reported to be the major pathogens associated with biomaterial-induced infections [7]. Scanning electron microscopy studies indicate that colonies of S. epidermidis are protected by a biofilm that is situated at the surface of the mesh fibers and may be responsible for late infections months or even years after the initial operation [17]. These biofilms may explain why prophylactic systemic antibiotics show no beneficial effect [7]
Conclusion
In conclusion our data confirm that an antibiotic surface modification of PVDF mesh samples is feasible. The results of the present investigation suggest that the surface modified PVDF mesh may be used advantageously in hernia repair with no additional short-term mesh-related complications in the experimental model. It was found to have no side effects as demonstrated by in vitro cytotoxicity measurements as well as in vivo biocompatibility determinations. However, animal experiments,
Acknowledgements
This work was supported by the German Federal Ministry of Education and Research (BMBF Grant Project No. 03N4024) and by the Deutsche Forschungsgemeinschaft (DFG KI 1320/2-1).
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