Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis

Abstract

Introduction Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines. Aim To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections. Methods This retrospective institutional review board–exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device. Main Outcome Measures Intraoperative culture data from infected IPPs. Results Two hundred twenty-seven intraoperative cultures (2002–2016) were obtained at salvage or explantation. No culture growth occurred in 33% of cases and gram-positive and gram-negative organisms were found in 73% and 39% of positive cultures, respectively. Candida species (11.1%), anaerobes (10.5%) and methicillin-resistant Staphylococcus aureus (9.2%) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25% of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62% to 86% of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation. Conclusion This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success.

Inflatable Penile Prostheses Implantation: Does Antibiotic Exposure Matter?

“… 19 In a retrospective multi-institutional study comprising 25 institutes, anaerobes, Candida and methicillin-resistant S aureus comprised nearly one third of positive cultures. 20 In this study, neither anaerobes nor Candida would have been isolated based on the incubation conditions, and S aureus was not detected.…”

Treatment of Penile Prosthesis Implant’s Infection

“…Among all the risk factors, the most important ones seem to be, without doubt, the presence of diabetes mellitus and the reintervention (defined as a change of penile prosthesis): in fact, while the incidence of infection after de novo implant is found only in 1–3% of the patients, in cases of revision surgery, the risk increases to 10% and in diabetic patients, it has even been reported to reach 18% [5]. Many of the selected articles addressed the prevention of PPI, but there is no clear consensus worldwide on certain topics, including the use of antibiotic therapy: about this topic, the 2 most relevant studies [6, 7] suggested that higher doses of gentamicin act as a protective factor; however, no significant association was found.…”

“…The study by Gross et al [7, 8] also identifies the most implicated pathogens: they obtained 227 intraoperative cultures at salvage or explantation and identified 204 organisms and documented a high incidence of infections with Escherichia coli (18.3%), coagulase-negative Staphylococcus (15%), Candida species (11.1%), MSSA (10.5%), and MRSA (9.2%). Intravenous antibiotic regimens for all patients at implantation were generally, but not always, consistent with AUA or EAU guidelines: 22% (49 of 227) received a cephalosporin (cefazolin) and an aminoglycoside (gentamicin) and 56% (126 of 227) received vancomycin and an aminoglycoside (gentamicin) at implantation.…”

De erectieprothese voor de behandeling van erectiele disfunctie: herintroductie in Nederland

“…De prothese moet met spoed verwijderd worden. Dit risico ligt in de laatste series rond de 1,4-8,9 % [5][6][7]. Een laaggradige infectie wordt meestal veroorzaakt door de Staphylococcus epidermidis.…”

“…Dan is de patiënt niet ziek en zichtbaar exsudaat is helder. Behandeling bestaat uit antibiotica en zo nodig een salvageprocedure [6,7]. Bij die procedure wordt de prothese in dezelfde setting vervangen.…”