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A photomicrograph showing budding yeast and pseudohyphae consistent with Candida spieces and inflammatory debris within the mesh. (Silver methenamine stain, original magnification 400×.)
Source publication
The use of biologic mesh, which is considered resistant to infection, has become common. It is preferred over synthetic mesh for use in contaminated fields. Fungal infection with infiltration of biologic mesh is rare and has not been reported. In this paper, we report a case of a patient who underwent multiple laparotomies and received multiple ant...
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Candida is the most common fungal class, causing both superficial and invasive diseases in humans. Although Candida albicans is the most common cause of fungal infections in humans, C. auris is a new emergent serious pathogen causing complications similar to those of C. albicans. Both C. albicans and C. auris are associated with high mortality rate...
Citations
... Candida spp is rarely reported as a causative organism of mesh infection, but it has been associated with acute postoperative infections, with biologic [26,27] and synthetic mesh [28]. In the setting of chronic infection, we isolated Candida spp seven times in six patients. ...
Purpose:
Mesh infection following hernia repair is one of the most dreaded complications of hernia surgery. Mesh sinus, infected seromas, mesh extrusion, and mesh-related enteric fistulas are common complications associated with synthetic mesh. This study aimed to review the microbiota of mesh infection in 100 patients submitted to mesh explantation.
Methods:
We reviewed the charts of patients presenting with a history of mesh infection lasting or arising six months or more after mesh placement. All patients who submitted to abdominal wall repair with complete removal of an infected mesh and presenting a positive culture were included. The microbiology analysis was based on positive cultures obtained from the fluids and tissues surrounding the mesh or positive cultures of the mesh. Microorganisms were divided into gram-positive or gram-negative, aerobic or anaerobic, and fungi.
Results:
Pure aerobic gram-positive cultures were encountered in 50% of the patients, followed by a combination of aerobic gram-positive/gram-negative (8%) and pure gram-negative cultures (6%). Anaerobes were recovered from 31% of patients. Fungi were recovered from 6%. Staphylococcus aureus was identified in 64% of cultures, with methicillin-resistant Staphylococcus aureus present in 42% and methicillin-sensitive Staphylococcus aureus in 22%. Among aerobic gram-negative infections, six (17%) were caused by multi-resistant bacteria, including Pseudomonas aeruginosa, Proteus mirabilis, Acinetobacter baumanii, Klebsiella pneumoniae complex, and Enterobacter cloacae complex.
Conclusion:
Staphylococcus aureus plays a significant role in the pathogenesis of synthetic mesh infection. Staphylococcus aureus, isolated in 64% of cultures, accounted for most single bacterial infections and was the prevalent germ in mesh sinus and infected seromas. Gram-negative infection occurred in 35%. Anaerobes occurred in 31%, commonly encountered in polymicrobial infections. Most fungi cultures happened in patients with enteric fistulas.
... Fungal mesh infections are extremely rare and an unusual complication of abdominal wall reconstruction [14]. In 2015, Forrester et al. [15], performed a systematic review reporting on nine cases in the literature [14][15][16][17][18][19][20][21][22]. Since then, only one other case has been described by Ober et al. [23], who outlined a devastating fungal mesh infection resulting in sepsis, hemodynamic instability and required mesh explantation. ...
... Since then, only one other case has been described by Ober et al. [23], who outlined a devastating fungal mesh infection resulting in sepsis, hemodynamic instability and required mesh explantation. In the aforementioned studies [14][15][16][17][18][19][20][21][22], most patients had one or more risk factors for fungal infection, such as enteric contamination and/or prolonged broad spectrum systemic antibiotics in the setting of critical illness. All but two of these cases required mesh explantation [20,21]. ...
Mesh infection after abdominal wall reconstruction is a rare and usually devastating complication. Herein, we describe a unique case of a delayed and non-lethal Candida albicans mesh infection after abdominal wall reconstruction with placement of a biologic graft impregnated with antibiotics. Mesh explantation was not required, and the wound healed by secondary intention. This work suggests that locally delivered antibiotics may change the culprit microbes of skin infections to more unusual species such as Candida spp. Future research is required to study the effect of including antifungal agents in the locally delivered antimicrobials for abdominal wall reconstructions with biological meshes.
... After implantation of the new mesh, Candida krusei (known to be resistant to fluconazole) was detected in wound cultures and, despite aggressive treatment with micafungin, the new mesh had to be explanted for source control. 16 The second reported case involved fungal infection of a synthetic mesh (Proceed) in a woman with emergent laparascopic paraumbilical hernia repair. Postoperative CT revealed a communicating fluid collection containing gas around the mesh, which was drained and cultured for C. albicans. ...
Biologic mesh is preferred over synthetic mesh for complex and contaminated abdominal wall repairs; however, there are very little data on the risks and complications associated with its use. We report the case of a 67-year-old man with failed synthetic mesh repair for recurrent ventral hernia, who subsequently required an abdominal wall reconstruction (AWR), including the intraperitoneal sublay of noncrosslinked biologic mesh. His postoperative course was complicated with catastrophic sepsis and sustained hemodynamic instability, responding only to mesh explantation. The biologic mesh was subsequently noted to be histologically infected with invasive Candida albicans. Although noncrosslinked biologic mesh is a valuable adjunct to AWR, it is not infection-resistant. Although it is rare, infection of any foreign tissue, including biologic mesh, can occur in the setting of complex ventral abdominal wall repairs. Clinicians should be watchful for such infections in complex repairs as they may require biologic mesh explantation for clinical recovery.
... During the systematic review for fungal mesh infections, nine cases from nine manuscripts were identified (Table 1). [10][11][12][13][14][15][16][17] Infection among male and female patients was reported equally (50%). Median patient age was 49.5 years. ...
Fungal mesh infections are a rare complication of hernia repairs with mesh. The first case of Coccidioides spp. mesh infection is described, and a systematic literature review of all known fungal mesh infections was performed. Nine cases of fungal mesh infection are reviewed. Female and male patients are equally represented, median age is 49.5 years, and critical illness and preinfection antibiotic use were common. Fungal mesh infections are rare, but potentially fatal, complications of hernias repaired with mesh.
© 2015 Blackwell Verlag GmbH.
