Besides holding your healing process back, a surgical wound infection can make you very sick, disfigure you, create fistulas require more procedures and surgeries or make a mess of your plans for the future. Synthetic surgical mesh intensifies your risk of infection after surgery because it drags bacteria into the deep recesses of your body and then acts like an over-generous host, allowing several difficult and stubborn types of bacteria to grow and multiply on its surface. Manufacturers have adamant about changing the mesh composition rather than finding a more natural and less toxic remedy for SUI (stress urinary incontinence) and POP (pelvic organ prolapse).
A surgical site infection is a nosocomial infection (hospital-acquired) that can occur within 30 days after surgery. Mesh-related infections, the most common complication after mesh surgery, cause “significant morbidity,” which, in plain English, means it makes you sick, very sick and for a long time. Nosocomial infections come under careful scrutiny by the State and Federal agencies. Over 3 million people have mesh inside their bodies and many of them want it taken out. However, the danger of stirring up the “germ soup” surrounding mesh implants should be considered before planning pelvic mesh removal surgeries.
While wound infection is a complicated topic, today blog offers an overview and links to a few articles about pelvic infections from established medical journals. You are welcome to print them and take to your doctor.
Cause: The environment in your vagina is different from the what’s on your skin—where most surgeries begin. Even when the cut is made abdominally, through your skin, for transvaginal mesh surgeries, the connection with your vagina is made inside your body. That makes you more vulnerable to the kinds of bacteria that like to live inside your vagina. Some vaginal bacteria hate light and love warmth so when they get pushed inside the deep pelvic spaces they continue to thrive and cause trouble. They form a bacterial wall called a biofilm on the surface of the mesh where the body’s natural defenses can’t reach. There are often several different bacteria causing a post-op pelvic infection, and these may include: gram-negative bacilli, enterococci, group B streptococci, and anaerobes. (More on those in a later blog.)
Types of pelvic surgical site infections: The three most common post-operative pelvic infections are vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. The infections, in order of severity, can be superficial, deep, or within the organ space.
A superficial infection, vaginal cuff cellulitis, involves the skin and subcutaneous tissue (just under the skin). You may feel pain or tenderness, localized swelling, redness, or heat over the area. Deep infections, pelvic cellulitis, involve the fascia, muscle, etc. You may have thick, yellow or brown drainage the wound, a spontaneously dehiscence or your surgeon may deliberately open your wound to allow drainage, fever over 100.4F (>38°C) degrees, pain in the surgical area, or tenderness. Lastly, you may have a deep abscess, pelvic abscess, requiring drainage. Infections involving organs and spaces around organs produce purulent (containing pus) drainage from a surgical drain, abscess, and include the signs of infection above.
Tests used to identify the extent of the infection include a thorough examination by your surgeon, or radiological exams like ultrasound, CT (computerized tomography), MRI (magnetic resonance imaging), or exploratory surgery. Your surgeon will probably take a culture of the wound to find out which bacteria is causing the infection and to prescribe the right antibiotic(s).
Risk Factors: You may be at greater risk of developing a post-op infection if you have diabetes, especially if your blood sugar goes over 150 mg/dL just before and after surgery or your hemoglobin is over 6.5% just before surgery. Other risk factors include obesity, (BMI> 30), anemia, prior strokes, tobacco, steroid use (like prednisone), malnutrition, increased age, prior radiation treatment to the site, or vaginal infection. The longer you are in the hospital before your surgery, the higher your risk for post operative infection.
Let your doctor know if you’ve had any recent bacterial infections. When you minimize your risk factors, you lessen your chance of getting a post-op infection.
Pre-op antibiotics: Before the invention of a process of giving pre-op prophylactic antibiotics, as many as 33 percent of patients ended up with pelvic infections. After prophylactic antibiotics were introduced, the number of infections dropped to 2.7%. Before pelvic surgery, ask your surgeon what is the plan for your antibiotic prophylaxis.
The most common prophylaxis follows the American Journal of Health-System Pharmacy recommendations: Cefazolin be given within an hour before or hour after the first incision. If the surgery goes longer than 3 hours, they repeated doses. Larger doses to be given to women over 265 pounds (120 kilograms). Chart of antibiotic guidelines here: Table 1 and Table 2 If you are allergic or resistant to one antibiotic, other ones can be given. Table 3 is a list of recommended antibiotics for pelvic mesh surgery infections separated by depth of infection.
If you are suffering from a pelvic surgical infection, take gentle care of yourself. Plan to rest, and take plenty of non-caffeinated, low- or no-sugar fluids. Eat the foods your mother made you finish: fruits and vegetables, proteins. Take multiple vitamins. Gather around you your most nurturing friends and relatives and send any annoying visits out to run errands. There are several support groups you can join to gather encouragement as you go through the long and slow process of of healing. May it be rapid.
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