Negative Pressure Wound Therapy for Treatment of Mesh Infection After Abdominal Surgery: Long-Term Results and Patient-Reported Outcome.

BACKGROUND AND AIMS: Treatment of synthetic mesh infections has previously often resulted in mesh explantation. Negative pressure wound therapy has been used in these situations with encouraging results. The aims of this study were to evaluate wound healing, mesh preservation, and patient-reported outcome after negative pressure wound therapy of mesh infections. MATERIAL AND METHODS: Medical records of patients treated with negative pressure wound therapy for mesh infection and age-matched mesh-operated controls without postoperative complications were scrutinized in a retrospective study. An abdominal wall complaints questionnaire was used to evaluate patient-reported outcome. RESULTS: Of 722 mesh operations performed 2005-2012, negative pressure wound therapy was used for treating postoperative mesh infections in 48 patients. A total of 48 age-matched controls were recruited from patients without wound complications. No differences were found between groups regarding preoperative characteristics. The following peroperative characteristics were significantly more frequent in the negative pressure wound therapy group: emergency operation, dirty/infected surgical field, surgical techniques other than laparoscopic intraperitoneal onlay mesh repair, implantation of more than one mesh, larger mesh size, longer duration of surgery, and mesh not completely covered with anterior rectus fascia. The entire mesh was salvaged in 92%, while four meshes were partly excised. Wounds healed in 88% after a median of 110 (range 3-649) days. In total, 85% in the negative pressure wound therapy group and 75% in the control group answered the questionnaire. There were no significant differences regarding pain, other abdominal wall symptoms, and satisfaction with the final result in favor of the controls. CONCLUSION: No mesh had to be explanted and wound healing was achieved in the majority of patients when negative pressure wound therapy was used for treatment of mesh infections. However, time to healing was long, and numerous procedures were sometimes needed. Positive long-term outcome was more frequently reported among controls.

Survival of Lactobacillus plantarum DSM 9843 (299v), and effect on the short-chain fatty acid content of faeces after ingestion of a rose-hip drink with fermented oats.

In a controlled and randomised double-blind study, 26 healthy adult volunteers consumed, for 21 d, 400 ml of a rose-hip drink containing oats (0.7 g/100ml) fermented with Lactobacillus plantarum DSM 9843 (RHL; containing 5 x 10(7) cfu ml(-1)), and 22 volunteers in a second group the same amount of a pure rose-hip drink (RH). Significant increases in the total faecal concentration of carboxylic acids (P < 0.05 after 1 week and P < 0.01 after 3 weeks of intake), acetic acid (P < 0.01 after 3 weeks of intake) and propionic acid (P < 0.01 after 3 weeks of intake and P < 0.05 eight days after intake ceased) were recorded in the RHL group, indicating increased fermentation in the colon. In both groups a significant increase was obtained in the concentration of faecal lactic acid (P < 0.001 after 1 and 3 weeks of intake). No changes were seen in the concentration of faecal butyrate. The numbers of faecal bifidobacteria and lactobacilli increased significantly in both groups after 3 weeks of intake. Sulphite-reducing clostridia rapidly decreased in the group receiving the product with Lb. plantarum DSM 9843 after 1 week of intake, and then also in the pure rose-hip group after 3 weeks of intake. No changes were seen in the numbers of total anaerobes, gram-negative anaerobes or total aerobes during administration. Lb. plantarum DSM 9843 was recovered in faeces from all volunteers in the RHL group. Median amounts were 7.0 (5.0-8.8) log10 cfu g(-1) after one week of intake, and 6.7 (5.0-8.9) log10 cfu g(-1) after 3 weeks, respectively. The strain was still recovered from faeces of five volunteers 8 d after administration ceased (> 4.8 log10 cfu g(-1)). During the period of intake the volunteers in the RHL group experienced a significant increase in stool volume, a significant decrease in flatulence and slightly softer stools. Volunteers in the RH group experienced a slight but significant decrease in stool volume.

Administration of different Lactobacillus strains in fermented oatmeal soup: in vivo colonization of human intestinal mucosa and effect on the indigenous flora.

In vivo colonization by different Lactobacillus strains on human intestinal mucosa of healthy volunteers was studied together with the effect of Lactobacillus administration on different groups of indigenous bacteria. A total of 19 test strains were administered in fermented oatmeal soup containing 5 x 10(6) CFU of each strain per ml by using a dose of 100 ml of soup per day for 10 days. Biopsies were taken from both the upper jejunum and the rectum 1 day before administration was started and 1 and 11 days after administration was terminated. The administration significantly increased the Lactobacillus counts on the jejunum mucosa, and high levels remained 11 days after administration was terminated. The levels of streptococci increased by 10- to 100-fold in two persons, and the levels of sulfite-reducing clostridia in the jejunum decreased by 10- to 100-fold in three of the volunteers 1 day after administration was terminated. In recta, the anaerobic bacterium counts and the gram-negative anaerobic bacterium counts decreased significantly by the end of administration. Furthermore, a decrease in the number of members of the Enterobacteriaceae by 1,000-fold was observed on the rectal mucosa of two persons. Randomly picked Lactobacillus isolates were identified phenotypically by API 50CH tests and genotypically by the plasmid profiles of strains and by restriction endonuclease analysis of chromosomal DNAs.(ABSTRACT TRUNCATED AT 250 WORDS)

Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome.

OBJECTIVE: The influence of the gastrointestinal (GI) microflora in patients with irritable bowel syndrome (IBS) has not been clearly elucidated. This study was undertaken to see if patients with IBS have an imbalance in their normal colonic flora, as some bacterial taxa are more prone to gas production than others. We also wanted to study whether the flora could be altered by exogenous supplementation. In a previous study we have characterized the mucosa-associated lactobacilli in healthy individuals and found some strains with good colonizing ability. Upon colonization, they seemed to reduce gas formation. METHODS: The study comprised 60 patients with IBS and a normal colonoscopy or barium enema. Patients fulfilling the Rome criteria, without a history of malabsorption, and with normal blood tests underwent a sigmoidoscopy with biopsy. They were randomized into two groups, one receiving 400 ml per day of a rose-hip drink containing 5 x 10(7) cfu/ml of Lactobacillus plantarum (DSM 9843) and 0.009 g/ml oat flour, and the other group receiving a plain rose-hip drink, comparable in color, texture, and taste. The administration lasted for 4 wk. The patients recorded their own GI function, starting 2 wk before the study and continuing throughout the study period. Twelve months after the end of the study all patients were asked to complete the same questionnaire regarding their symptomatology as at the start of the study. RESULTS: All patients tolerated the products well. The patients receiving Lb. plantarum had these bacteria on rectal biopsies. There were no major changes of Enterobacteriaceae in either group, before or after the study, but the Enterococci increased in the placebo group and remained unchanged in the test group. Flatulence was rapidly and significantly reduced in the test group compared with the placebo group (number of days with abundant gas production, test group 6.5 before, 3.1 after vs 7.4 before and 5.6 after for the placebo group). Abdominal pain was reduced in both groups. At the 12-month follow-up, patients in the test group maintained a better overall GI function than control patients. There was no difference between the groups regarding bloating. Fifty-nine percent of the test group patients had a continuous intake of fermented products, whereas the corresponding figure for the control patients was 73%. CONCLUSIONS: The results of the study indicate that the administration of Lb. plantarum with known probiotic properties decreased pain and flatulence in patients with IBS. The fiber content of the test solution was minimal and it is unlikely that the fiber content could have had any effect. This type of probiotic therapy warrants further studies in IBS patients.

The normal Lactobacillus flora of healthy human rectal and oral mucosa.

The Lactobacillus flora of the rectal and oral mucosa was sampled from 42 healthy volunteers. Species identification was carried out by numerically comparing API 50CH fermentation patterns with type strains, using an SJ-similarity cut-off level of 79%. For the largest groups, identity was further confirmed by DNA-DNA hybridizations against the type strain of the species. Seventeen lactobacilli clusters were defined, of which most were found both on rectal and oral mucosa. The largest taxa were Lactobacillus plantarum, Lact. rhamnosus and Lact. paracasei ssp. paracasei, which were isolated from 52%, 26% and 17% of the individuals, respectively. Most isolates were tested for their capacity to adhere to the human colonic cell line HT-29 in the absence and presence of methyl-alpha-D-mannoside. Mannose-sensitive adherence to HT-29 cells was encountered in two-thirds of the Lact. plantarum isolates, but infrequently among isolates of other taxa. The results suggest that Lact. plantarum is a major colonizer of the human gastrointestinal mucosa, and that its capacity to adhere to mannose-containing receptors may be of some ecological importance.

The effects of Lactobacillus strains and oat fiber on methotrexate-induced enterocolitis in rats.

BACKGROUND & AIMS: Administration of methotrexate to rats on an elemental diet results in severe enterocolitis and death. Lactobacilli, an integral part of the healthy gastrointestinal microecology, may provide therapeutic benefits to help the recovery from enterocolitis. The purpose of this study was to evaluate the effects of lactobacilli and oatbase on methotrexate-induced enterocolitis in rats. METHODS: Rats received continuous intragastric infusion of elemental diet or with supplementation of oatbase, Lactobacillus reuteri R2LC, and Lactobacillus plantarum DSM 9843, with and without fermentation, from the beginning of the study. Methotrexate (20 mg/kg) was injected intraperitoneally on day 3, and the sampling was performed on day 6. RESULTS: Lactobacilli and oatbase decreased body weight loss and intestinal permeability and increased bowel mucosal mass in enterocolitic rats. Administration of lactobacilli, but not oatbase, decreased the intestinal myeloperoxidase level, reestablished intestinal microecology, and reduced bacterial translocation to extraintestinal sites. Both lactobacilli and oatbase reduced plasma endotoxin levels. The effects of lactobacilli were greater with fermentation than without fermentation or oatbase alone, and L. plantarum was more effective in reducing intestinal pathogens than L. reuteri. CONCLUSIONS: Exogenous administration of lactobacilli, especially L. plantarum with fermentation, is helpful in reducing the severity of enterocolitis in rats.

Numerical taxonomy of Lactobacillus spp. associated with healthy and diseased mucosa of the human intestines.

Two-hundred and fifty Lactobacillus strains isolated from healthy and diseased mucosa of human intestines of 75 individuals and 49 reference strains were phenotypically classified using 49 unit characters. Data were processed by the Jaccard (SJ) and Simple Matching (SSM) coefficients, and unweighted pair group algorithm with arithmetic averages. Seventeen major clusters were defined at the 76% SJ-similarity level which approximately correspond to the SSM-level of 91%. Seven clusters could be identified: Lactobacillus plantarum (isolates recovered from 5% of the patients), Lact. casei subsp. rhamnosus (17% of the patients), Lact. casei subsp. pseudoplantarum (5% of the patients), Leuconostoc mesenteroides subsp. mesenteroides (3% of the patients), Lact. buchneri (4% of patients), Lact. reuteri (4% of the patients) and Lact. salivarius subsp. salivarius (9% of the patients). Unassigned clusters 1 and 3 both contained homofermentative Lactobacillus strains. Cluster 1 included the type strains of Lact. crispatus, Lact. acidophilus, Lact. jensenii and Lact. gasseri, and cluster 3, the type strains of Lact. delbrueckii subsp. lactis, Lact. agilis and Lact. casei subsp. tolerans. Clusters 1 and 3 were found in 15% and 25% of the patients, respectively. Unassigned clusters 2, 6, 7, 8 and 10 contained homofermentative Lactobacillus strains but no reference strains. Clusters 11, 12, 15 and 17 were made up of heterofermentative Lactobacillus strains but no reference strains. Phenotypical characteristics of the clusters are given. No obvious trends in species (cluster) composition between different intestinal locations could be noted. Most clusters contained isolates from both diseased and healthy mucosa. Exceptions were cluster 15 and cluster 17 which only included isolates from healthy mucosa, and cluster 11 which only included isolates from diseased mucosa. Cluster 15 was isolated in 12% of the patients, and cluster 11 in 8%.

Administration of Lactobacillus plantarum 299v reduces side-effects of external radiation on colon anastomotic healing in an experimental model.

OBJECTIVE: Preoperative radiotherapy of patients with rectal carcinoma is frequently used to reduce the incidence of local recurrence. However, the radiation therapy is associated with several complications, including diarrhea, retarded anastomotic healing and mucosal atrophy. Exogenous administration of lactobacilli has been demonstrated to be effective in stimulating intestinal mucosal growth and reduce mucosal inflammation. The objective of this study was to examine the effects of Lactobacillus plantarum 299v administration on external radiation injury in colon anastomotic healing at different time points. MATERIAL AND METHODS: Sprague-Dawley rats were treated with Lb. plantarum 299v or saline as control and received external radiation of the lower abdomen (10 Gy/day) on day 3 and 7 of the experiment. After 4 days, a colonic resection with anastomosis was performed. Animals were sacrificed on 4th, 7th and 11th day postoperatively. Body weight, white blood cell (WBC) count, mucosal myeloperoxidase (MPO) activity, hydroxyproline, nucleotide, DNA and RNA content, colonic bacterial microflora, bacterial translocation and histology were evaluated. RESULTS: On the 4th postoperative day body weight, WBC and MPO decreased significantly after radiation. On the 7th postoperative day MPO decreased after radiation. In the two irradiated groups it decreased significantly in the Lb. plantarum group compared to the radiated group without treatment. Collagen concentration on the 7th postoperative day was significantly higher in Lb. plantarum group without radiation compared to the group with radiation without Lb. plantarum. On the 11th postoperative day MPO was significantly higher in irradiated rats without treatment compared to Lb. plantarum treatment. The collagen concentration increased significantly in the irradiated Lb. plantarum group compared to the other two groups. CONCLUSION: The collagen content decreased and MPO activity increased significantly of the colonic anastomosis in irradiated rats without treatment compared to those treated with Lb. plantarum. It therefore seems that administration of Lactobacillus plantarum 299v reduces the intestinal injury and inflammation following external radiation and improves the colonic anastomotic healing.

Pectin-supplemented enteral diet reduces the severity of methotrexate induced enterocolitis in rats.

BACKGROUND: Administration of methotrexate (MTX) to rats fed an elemental diet results in a high mortality from severe enterocolitis. Previous studies have shown that pectin is an important precursor of substrates for intestinal structure and function and may facilitate intestinal recovery after enterocolitis. The aim of this study is to evaluate the effect of pectin on MTX-induced enterocolitis in rats. METHODS: Rats received intragastric infusion of either 1% pectin-supplemented or pectin-free elemental diet from the beginning of the study via a gastrostomy. On the 4th day animals received either MTX, 20 mg/kg intraperitoneally, or saline injection and were killed on the 7th day for sampling. RESULTS: Pectin supplementation significantly decreased body weight loss, organ water content, and intestinal myeloperoxidase levels and increased mucosal protein, DNA, and RNA content in enterocolitis rats. The intestinal permeability was increased by administration of MTX, and pectin supplementation significantly reversed the increased permeability in the distal small bowel and colon. Pectin supplementation also lowered the magnitude of bacterial translocation, decreased plasma endotoxin levels, and restored bowel microecology. CONCLUSIONS: Pectin significantly decreased MTX-induced intestinal injury and improved bowel integrity.