Pérez-Köhler Bárbara, Bayon Yves, Bellón Juan Manuel
1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .
2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain .
Surg Infect (Larchmt). 2016 Apr;17(2):124-37. doi: 10.1089/sur.2015.078. Epub 2015 Dec 10.
The use of a prosthetic mesh to repair a tissue defect may produce a series of post-operative complications, among which infection is the most feared and one of the most devastating. When occurring, bacterial adherence and biofilm formation on the mesh surface affect the implant's tissue integration and host tissue regeneration, making preventive measures to control prosthetic infection a major goal of prosthetic mesh improvement.
This article reviews the literature on the infection of prosthetic meshes used in hernia repair to describe the in vitro and in vivo models used to examine bacterial adherence and biofilm formation on the surface of different biomaterials. Also discussed are the prophylactic measures used to control implant infection ranging from meshes soaked in antibiotics to mesh coatings that release antimicrobial agents in a controlled manner.
Prosthetic architecture has a direct effect on bacterial adherence and biofilm formation. Absorbable synthetic materials are more prone to bacterial colonization than non-absorbable materials. The reported behavior of collagen biomeshes, also called xenografts, in a contaminated environment has been contradictory, and their use in this setting needs further clinical investigation. New prophylactic mesh designs include surface modifications with an anti-adhesive substance or pre-treatment with antibacterial agents or metal coatings.
The use of polymer coatings that slowly release non-antibiotic drugs seems to be a good strategy to prevent implant contamination and reduce the onset of resistant bacterial strains. Even though the prophylactic designs described in this review are mainly focused on hernia repair meshes, these strategies can be extrapolated to other implantable devices, regardless of their design, shape or dimension.
使用人工合成网片修复组织缺损可能会引发一系列术后并发症，其中感染是最令人担忧且危害最大的并发症之一。感染发生时，网片表面的细菌黏附及生物膜形成会影响植入物与组织的整合以及宿主组织的再生，因此，控制人工合成网片感染的预防措施成为改进人工合成网片的主要目标。
本文回顾了关于用于疝修补的人工合成网片感染的文献，描述了用于检测不同生物材料表面细菌黏附及生物膜形成的体外和体内模型。还讨论了用于控制植入物感染的预防措施，从浸泡抗生素的网片到以可控方式释放抗菌剂的网片涂层。
人工合成网片的结构对细菌黏附及生物膜形成有直接影响。可吸收合成材料比不可吸收材料更容易发生细菌定植。胶原蛋白生物网片（也称为异种移植物）在污染环境中的表现报道不一，其在这种情况下的使用需要进一步的临床研究。新的预防性网片设计包括用抗黏附物质进行表面改性、用抗菌剂预处理或金属涂层处理。
使用能缓慢释放非抗生素药物的聚合物涂层似乎是预防植入物污染和减少耐药菌株出现的良好策略。尽管本综述中描述的预防性设计主要集中在疝修补网片上，但这些策略可推广到其他可植入装置，无论其设计、形状或尺寸如何。
