1. Transvaginal Mesh-Related Complications and the Potential Role of Bacterial Colonization: an Exploratory Observational Study
- Author
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Chantal M. Diedrich, Kim W.J. Verhorstert, Martijn Riool, Heleen Schuster, Leonie de Boer, Judith Kikhney, Annette Moter, Sebastian A.J. Zaat, and Jan-Paul W.R. Roovers
- Subjects
Obstetrics and Gynecology - Abstract
The aim of this study was to investigate the potential role of transvaginal mesh bacterial colonization in the development of mesh-related complication (MRCs).An observational and exploratory study was performed including 49 patients indicated for mesh removal and 20 women of whom vaginal tissue was retrieved during prolapse surgery as a reference cohort.Homogenized samples were used for quantitative microbiological culture. Inflammation and fibrosis were semi-quantitatively histologically scored, Gram staining and Fluorescence in situ Hybridization (FISH) was used to detect bacteria and bacterial biofilms.Of the 49 patients, 44 (90%) samples were culture positive, with a higher diversity of species, more Gram-negative bacteria and polymicrobial cultures in the MRC cohort compared to the reference cohort, with mostly staphylococci, streptococci, Actinomyces spp., Cutibacterium acnes and Escherichia coli. Patients with clinical signs of infection or exposure had the highest bacterial counts. Histology demonstrated moderate to severe inflammation in the majority of samples. Gram staining showed bacteria in 57% of culture positive samples and in selected samples FISH illustrated a polymicrobial biofilm.In this study we observed distinct differences in bacterial numbers and species between patients suffering from MRCs compared to a reference cohort. Bacteria were observed at the mesh-tissue interface in a biofilm. These results strongly support the potential role of bacterial mesh colonization in the development of MRCs.
- Published
- 2022