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Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation
Jun Zhang1, Yuming Zhou1, Zhenzhou Zhong1
1Department of Emergency Medicine, Ganzhou People's Hospital, Ganzhou, 341000, China.
Abstract:
Infection following inguinal hernia repair (IHR) is uncommon. Rational use of antibiotics can significantly improve the prognosis of patients. However, accurately identifying the pathogen involved is usually challenging. This case report describes a patient who developed intermittent fever after undergoing open preperitoneal tension-free repair of a bilateral inguinal hernia. The scrotal fluid specimen was cultured and subjected to metagenomic next-generation sequencing (mNGS). Culture revealed the presence of Enterococcus faecalis (a facultative anaerobe). However, mNGS detected E. faecalis along with multiple anaerobic bacteria including Bacteroides thetaiotaomicron, Parabacteroides distasonis, and Levyella massiliensis. The patient was finally diagnosed with a mixed infection of E. faecalis and multiple anaerobes, and his condition was effectively controlled after timely adjustment of the antibiotic regimen. Treating postoperative infections with multiple concurrent conditions can be challenging. mNGS is valuable for the accurate diagnosis and treatment of infections, as it not only can further verify the culture results, but also assist clinicians in ruling out pulmonary infection caused by hematogenous dissemination after IHR in patients.
Insights
Post-inguinal hernia repair infections are rare but challenging. Metagenomic next-generation sequencing (mNGS) accurately identified a mixed bacterial infection, improving patient outcomes.
Area of Science:
- Infectious Diseases
- Surgical Site Infections
- Microbiology
Background:
- Infections following inguinal hernia repair (IHR) are infrequent but can complicate patient recovery.
- Accurate identification of causative pathogens is crucial for effective antibiotic therapy but often challenging.
- Standard culture methods may not detect all microorganisms involved in complex infections.
Observation:
- A patient presented with intermittent fever after open preperitoneal tension-free bilateral inguinal hernia repair.
- Scrotal fluid culture identified *Enterococcus faecalis*.
- Metagenomic next-generation sequencing (mNGS) detected *E. faecalis* and multiple anaerobic bacteria, including *Bacteroides thetaiotaomicron*, *Parabacteroides distasonis*, and *Levyella massiliensis*.
Findings:
- mNGS revealed a mixed infection involving *E. faecalis* and several anaerobic species, a finding missed by culture alone.
- The patient's condition improved significantly after antibiotic regimen adjustment based on comprehensive mNGS results.
- mNGS proved valuable in confirming culture findings and aiding in the differential diagnosis of potential hematogenous spread infections.
Implications:
- Metagenomic next-generation sequencing (mNGS) offers superior diagnostic accuracy for complex postoperative infections compared to traditional cultures.
- This case highlights the potential for polymicrobial anaerobic infections after IHR.
- mNGS can guide targeted antibiotic therapy, leading to better patient outcomes and potentially reducing the need for broad-spectrum antibiotics.
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