Inguinal hernia mesh infections: Chronic challenges, atypical pathogens and lessons in sterilisation

Chronic mesh infections after inguinal hernia repair present significant clinical challenges due to biofilm-mediated resistance, involvement of multidrug-resistant and atypical pathogens, and gaps in preventive strategies. Our case series of four patients highlights critical research gaps, including the overlooked role of atypical pathogens such as Mycobacterium tuberculosis, diagnostic challenges in detecting slow-growing or resistant organisms and perioperative sterilisation lapses, especially inconsistent Glutaraldehyde use during late-day operations. Many patients suffered with persistent sinuses and recurrent hernias months after surgery. Microbiological analyses identified Pseudomonas aeruginosa, Klebsiella pneumoniae, Mycobacterium tuberculosis and mixed flora. Complete mesh removal and culture-directed antimicrobial therapy resolved all cases within 8-12 months. Our study underscores the need for robust sterilisation protocols, advanced diagnostic measures and biofilm-resistant biomaterials.