Failure to obtain microbiological culture and its consequence in a mesh-related infection

This report describes a case of a delayed diagnosis of a late-onset mesh infection due to an unexpected enteric pathogen, Enterobacter cloacae. A 62-year-old woman with a history of prior incisional hernia repair with a prosthetic mesh presented to the emergency room with signs of an abscess with surrounding cellulitis of her abdomen over a year after her hernia repair. The patient manifested minimal response to 1 month of oral antibiotics. She underwent a complicated yet successful treatment course including surgical mesh removal (with a peri-operative complication), implantation of a biological mesh for the ventral hernia defect and ultimately, antibiotics tailored to the offending pathogen identified by postoperative culture of the infected mesh.