Management and outcome of mesh infection after abdominal wall reconstruction in a tertiary care center

Abdominal wall reconstruction is a common surgical procedure, with a post-operative risk of mesh-associated infection of which management is poorly known. This study aims to comprehensively analyze clinical and microbiological aspects of mesh infection, treatment modalities, and associated outcomes.

Patients with abdominal mesh infection were included in a retrospective observational cohort (2010-2023). Patients characteristics and management were described, and determinants for failure were assessed by logistic regression and treatment failure-free survival curve analysis (Kaplan-Meier).

Two hundred and nine patients (median age, 62 [IQR, 55-71] years) presented a mesh infection occurring within 15 (IQR, 7-31) days after surgery, mainly as an abdominal wall or deep abscess (n=189, 90.4%). Infection was polymicrobial in 89/166 (79.4%) cases, S. aureus (n=60, 36.1%), Enterobacteriaceae (n=60, 36.1%) and anaerobes (n=40, 24.1%) being the most prevalent pathogens. Surgery was performed in 130 (62.2%) patients, associated with a 13.5 (IQR, 8-21) day course of antimicrobial therapy in 172/207 (83.1%) cases. Sixty-three (30.1%) treatment failures occurred, associated with previous multiple abdominal surgeries (OR, 3.305; 95%CI, 1.297-8.425), complete mesh removal (OR, 0.145; 95%CI, 0.063-0.335) and antimicrobial therapy (OR, 0.328; 95%CI, 0.136-0.787). The higher failure rate of conservative strategies was associated with symptom duration >1 month (OR, 3.378; 95%CI, 1.089-4.005) and retromuscular mesh position (OR, 0.444; 95%CI, 0.199-0.992).

Mesh infection is associated with high treatment failure rates. Complete mesh removal coupled with targeted antibiotic therapy is associated with better outcomes. Conservative treatment strategies must rely on careful patient selection based on symptom duration and mesh placement.