Digestive, bariatric and endocrine surgery unit, hôpital Avicenne, AP-HP, Bobigny, France.
Digestive, bariatric and endocrine surgery unit, hôpital Avicenne, AP-HP, Bobigny, France.
J Visc Surg. 2023 Apr;160(2):85-89. doi: 10.1016/j.jviscsurg.2023.02.007. Epub 2023 Mar 17.
Infectious complications of parietal mesh after prosthetic abdominal wall repair are rare. Their management is complex. Furthermore, the emergence of bacterial resistance, the presence of a foreign material, the need to continue an extended antibiotic therapy, and the choice of an appropriate treatment are crucial. The objective of this study is to access the microbiological epidemiology of infected parietal meshes in order to optimize the empirical antibiotic therapy.
Between January 2016 and December 2021, a monocentric and retrospective study was performed in patients hospitalized for infected parietal meshes at Avicenne hospital, in Paris area. Clinical and microbiological data such as antibiotic susceptibility were collected.
Twenty-six patients with infected parietal meshes have been hospitalized during this period. Meshes were in preaponevrotic positions (n=10; 38%), retromuscular (n=6; 23%) and intraperitoneal (n=10; 38%). Among the 22 (84.6%) documented cases of infections, 17 (77.3%) were polymicrobial. A total of 54 bacteria were isolated, 48 of which had an antibiogram available. The most frequently isolated bacteria were: Enterobacterales (n=19), Enterococcus spp. (n=11) and Staphylococcus aureus (n=6), whereas anaerobes were poorly isolated (n=3). Concerning these isolated bacteria, amoxicillin-clavulanic acid, metronidazole-associated cefotaxime, piperacillin-tazobactam and meropenem were susceptible in 45.5%, 68.2%, 63.6%, 77.2%, of cases, respectively.
This work highlights that infections of abdominal parietal meshes may be polymicrobial and the association amoxicillin-clavulanic acid cannot be used as a probabilist antibiotic therapy because of the high resistance rate in isolated bacteria. The association piperacillin-tazobactam appears to be a more adapted empirical treatment to preserve carbapenems, a broad-spectrum antibiotic class.
人工腹壁修复术后壁层网格感染并发症罕见，但处理复杂。此外，细菌耐药性的出现、异物的存在、需要继续延长抗生素治疗以及选择合适的治疗方法都至关重要。本研究旨在评估感染性壁层网格的微生物流行病学，以优化经验性抗生素治疗。
2016 年 1 月至 2021 年 12 月，在巴黎地区阿维森纳医院，对因感染性壁层网格住院的患者进行了一项单中心、回顾性研究。收集了临床和微生物学数据，如抗生素敏感性。
在此期间，共有 26 例感染性壁层网格患者住院。网格位于前腹侧（n=10；38%）、腹直肌后（n=6；23%）和腹腔内（n=10；38%）。在 22 例（84.6%）有记录的感染病例中，17 例（77.3%）为混合感染。共分离出 54 株细菌，其中 48 株有药敏试验结果。最常分离的细菌为：肠杆菌科（n=19）、肠球菌属（n=11）和金黄色葡萄球菌（n=6），而厌氧菌分离较少（n=3）。关于这些分离的细菌，阿莫西林克拉维酸、甲硝唑联合头孢噻肟、哌拉西林他唑巴坦和美罗培南的敏感性分别为 45.5%、68.2%、63.6%和 77.2%。
本研究表明，腹壁壁层网格感染可能为混合感染，由于分离细菌的高耐药率，阿莫西林克拉维酸不能作为概率性抗生素治疗。哌拉西林他唑巴坦联合治疗似乎是一种更适合的经验性治疗方法，可以保留广谱抗生素类药物碳青霉烯类。
