Microbiology of Mesh Infections after Ventral Hernia Repair

Authors:
Coleman Miller, Edwin George Mathew, Dalya Ferguson, Julie Holihan, Thomas Clements, Jonah Stulberg

Body of Abstract:
Background

More than 600,000 ventral hernia repairs are performed in the United States annually. While rare, mesh infection is a devastating complication for patients which can result in years of painful surgeries and recurring hospitalizations. Despite the significance of this problem, there is very little data regarding the current microbiology of mesh infections. Previous studies have suggested that methicillin-resistant staphylococcus aureus (MRSA) is responsible for more than 50% of mesh infections, however with changing mesh types and the increasing use of minimally invasive techniques, we sought to determine the current microbiology of mesh infections at our complex hernia center.

Methods

We utilized our IRB approved, hernia quality database that captures detailed pre-, intra- and post-operative data on 100% of hernia cases performed by our four dedicated hernia surgeons. All patients with a known mesh infection were included in this study. Patients were excluded if there were no cultures obtained at the time of surgery. We extracted demographic variables and operative details from our hernia registry and then used chart review to evaluate cultures from the time of surgery.

Results

Our database contains 662 unique patients who have undergone ventral hernia repair between August of 2021 and June of 2025. All 13 patients who came to our institution with a mesh infection and had cultures obtained at the time of surgery had Gram-Positive bacteria in their samples. Seven cultures (54%) resulted as Staphylococcus aureus, with a majority exhibiting methicillin resistance (MRSA) (31% of all samples). Seven cultures (54%) resulted as Enterococcus spp. with one culture demonstrating both Staphylococcus aureus and Enterococcus spp.. Seven patients had polymicrobial infections with Gram-negative and Gram-positive organisms. The most common Gram-negative organisms were Klebsiella spp. (4, 31%) and E. coli (4, 31%), with Proteus spp. (3, 23%) and Pseudomonas spp. (2, 15%).

Conclusion

There is very little published data regarding the rate of chronic mesh infection after ventral hernia repair or the bacteria responsible for these infections. It is critical to understand the bacteria responsible if we hope to eliminate this adverse outcome. Our results demonstrate the diversity of bacteria involved in chronic mesh infections and therefore the diversity of sources of infection and highlight the need for further study in this area.