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Actinomyces in explanted transvaginal mesh: commensal or pathogen?
Susana Mustafa Mikhail1,2, Peta Fairweather3, Anna Eastman3
1Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. mustafa.susana@gmail.com.
Introduction And Hypothesis:
There is a paucity of information in the literature regarding the clinical impact and treatment of histologically positive actinomycosis explanted vaginal mesh. We aimed to report the prevalence and independent predicators of Actinomyces presence in explanted meshes on histology and to compare the clinical course in those with and without Actinomyces. Our hypothesis is that Actinomyces may act as a commensal rather than a pathogen when identified in extracted transvaginal meshes.
Methods:
A single-center retrospective review of explanted vaginal mesh removed between 2013 and 2018 was undertaken and compared Actinomyces-positive and -negative cohorts on histology. Uni- and multivariate logistic regression analysis evaluated possible risk factors for positive Actinomyces including patient demographics, smoking, diabetes, hormone replacement therapy (vaginal/systemic), hysterectomy in primary surgery, rate and indication for prior mesh removal. The rate of symptom resolution or need for subsequent mesh excisions is compared between the two cohorts.
Results:
Actinomycosis was identified in 11% (31/278) of explanted mesh. After multivariant analysis, only voiding dysfunction as an indication for mesh removal was statistically significantly associated with Actinomyces-negative histology (14 vs 0%, p < 0.001). At median review of 17 months, symptom resolution (87% vs 83% p = 0.68) and need for subsequent mesh removal (13% vs 19%, p = 0.37) following index mesh excision were similar between the groups.
Conclusion:
Actinomyces in explanted transvaginal mesh frequently acts as a commensal in those who are infection free. In this cohort, individualized care including conservative surveillance without antibiotics or full explantation is reasonable.
Insights
Actinomyces in explanted vaginal mesh often acts as a commensal, not a pathogen. Patients with Actinomyces-positive mesh showed similar outcomes to those without, suggesting conservative management is reasonable.
Area of Science:
- Gynecology
- Pathology
- Microbiology
Background:
- Limited data exists on the clinical impact of Actinomyces in explanted vaginal mesh.
- Actinomyces presence in mesh is poorly understood, with its role as pathogen or commensal unclear.
Purpose of the Study:
- To determine the prevalence and predictors of Actinomyces in explanted vaginal meshes.
- To compare clinical outcomes between patients with and without Actinomyces in explanted meshes.
- To investigate if Actinomyces acts as a commensal or pathogen in this context.
Main Methods:
- Retrospective review of explanted vaginal meshes (2013-2018).
- Histological comparison of Actinomyces-positive and -negative explants.
- Logistic regression analysis for risk factors and comparison of symptom resolution and re-excision rates.
Main Results:
- Actinomyces identified in 11% of explanted meshes.
- Voiding dysfunction was associated with Actinomyces-negative histology.
- Symptom resolution and need for further surgery were similar between Actinomyces-positive and -negative groups.
Conclusions:
- Actinomyces in explanted transvaginal mesh often functions as a commensal in infection-free individuals.
- Individualized care, including conservative surveillance without antibiotics, is a reasonable approach.
- Full mesh explantation may not be necessary for all cases with Actinomyces presence.
