Wound infections due to Mycobacterium fortuitum after polypropylene mesh inguinal hernia repair

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Summary

Mycobacterium fortuitum complex is a group of rapidly growing mycobacteria (RGM). These opportunistic pathogens are frequently associated with infections related to surgical procedures involving biomaterials. Two cases of Mycobacterium fortuitum infection occurred in a prospective study of inguinal hernia prosthesis repairs. These infections differed from those caused by other bacteria in terms of pathogenic mechanisms, clinical manifestation and resistance to both prophylactic and therapeutic antibiotics.

Introduction

Rapidly growing mycobacteria (RGM) are ubiquitous organisms that can be considered opportunistic pathogens. Members of the Mycobacterium fortuitum complex are the group of RGM most frequently isolated in human infections.1 Many infections have been associated with surgical procedures using devices such as orthopaedic prosthesis, peritoneal dialysis catheters, vascular catheters and prosthetic heart valves.2 Two cases of RGM infections after mesh abdominal wall hernia repairs have previously been reported, one of them caused by M. fortuitum.3, 4 Here, we report two cases of M. fortuitum infection from a prospective study of inguinal hernia prosthesis repairs performed as day surgery. Pathogenic mechanisms, clinical manifestation and resistance to prophylactic and therapeutic antibiotics are considered.

Section snippets

Methods

Patients were operated in a hospital autonomous ambulatory care unit with an open polypropylene, tension-free hernioplasty protocol according to McVay's criteria, utilizing the Lichtenstein technique or a modification of it described by the authors.5 Female patients were treated with the former. Occasional patients with crural recurrences after inguinal hernioplasty or herniorraphy were treated with a plug technique or a preperitoneal mesh.

Patients had American Society of Anesthesiology (ASA)

Results

A total of 688 patients underwent operation between July 1996 and December 2005. No superficial infections were found. Two patients presented with late deep infections caused by M. fortuitum.

Discussion

Two types of wound infection occur after prosthetic hernia repair.9 Superficial infections occur in the early postoperative period and can be resolved with antibiotic and drainage. Removal of the prosthesis may not be necessary. A single dose of prophylactic antibiotic significantly reduces the incidence of superficial wound infection after mesh inguinal hernia repair and none occurred during our study.7, 10 Late-onset mesh infections appear several weeks or months after the operation and the

Acknowledgement

Part of this work has been financed by a grant from the FIS (PI 030146).

References (18)

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