Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.
Macquarie University Hospital, Macquarie University, Sydney, Australia.
Hernia. 2022 Oct;26(5):1293-1299. doi: 10.1007/s10029-022-02583-0. Epub 2022 Mar 14.
The purpose of this study was to investigate the link between bacterial biofilms and negative outcomes of hernia repair surgery. As biofilms are known to play a role in mesh-related infections, we investigated the presence of biofilms on hernia meshes, which had to be explanted due to mesh failure without showing signs of bacterial infection.
In this retrospective observational study, 20 paraffin-embedded tissue sections from explanted groin hernia meshes were analysed. Meshes have been removed due to chronic pain, hernia recurrence or mesh shrinkage. The presence and bacterial composition of biofilms were determined. First, specimens were stained with fluorescence in situ hybridisation (FISH) probes, specific for Staphylococcus aureus and coagulase-negative staphylococci, and visualised by confocal laser scanning microscopy. Second, DNA was extracted from tissue and identified by S. aureus and S. epidermidis specific PCR.
Confocal microscopy showed evidence of bacterial biofilms on meshes in 15/20 (75.0%) samples, of which 3 were positive for S. aureus, 3 for coagulase-negative staphylococci and 9 for both species. PCR analysis identified biofilms in 17/20 (85.0%) samples, of which 4 were positive for S. aureus, 4 for S. epidermidis and 9 for both species. Combined results from FISH/microscopy and PCR identified staphylococci biofilms in 19/20 (95.0%) mesh samples. Only 1 (5.0%) mesh sample was negative for bacterial biofilm by both techniques.
Results suggest that staphylococci biofilms may be associated with hernia repair failure. A silent, undetected biofilm infection could contribute to mesh complications, chronic pain and exacerbation of disease.
本研究旨在探讨细菌生物膜与疝修补术后不良结局之间的关系。由于生物膜在与网片相关的感染中起作用，我们研究了因网片失败而不得不取出但无细菌感染迹象的疝修补网片中生物膜的存在情况。
在这项回顾性观察研究中，分析了 20 例因慢性疼痛、疝复发或网片收缩而取出的腹股沟疝修补网片的石蜡包埋组织切片。生物膜的存在和细菌组成用荧光原位杂交（FISH）探针进行检测，探针特异性针对金黄色葡萄球菌和凝固酶阴性葡萄球菌，并用共聚焦激光扫描显微镜观察。然后，从组织中提取 DNA，并通过金黄色葡萄球菌和表皮葡萄球菌特异性 PCR 进行鉴定。
共聚焦显微镜显示，15/20（75.0%）例样本的网片上有细菌生物膜的证据，其中 3 例为金黄色葡萄球菌阳性，3 例为凝固酶阴性葡萄球菌阳性，9 例为两种细菌均阳性。PCR 分析显示 17/20（85.0%）例样本中有生物膜，其中 4 例为金黄色葡萄球菌阳性，4 例为表皮葡萄球菌阳性，9 例为两种细菌均阳性。FISH/显微镜和 PCR 的联合结果在 19/20（95.0%）例网片样本中鉴定出葡萄球菌生物膜。两种技术均未发现细菌生物膜的网片样本仅为 1 例（5.0%）。
结果表明，葡萄球菌生物膜可能与疝修补术失败有关。沉默的、未被发现的生物膜感染可能导致网片并发症、慢性疼痛和疾病恶化。
