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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.
International Urogynecology Journal
|January 8, 2021
Summary
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.
