Silverstein Ari D, Henry Gerard D, Evans Brian, Pasmore Mark, Simmons Caroline J, Donatucci Craig F
Hoard, Taub, Freedman and Rauch, Boca Raton, Florida, USA.
J Urol. 2006 Sep;176(3):1008-11. doi: 10.1016/j.juro.2006.04.034.
Biofilms are matrix enclosed bacterial populations that adhere to each other and/or to surfaces of implanted medical devices. Biofilm formation has consistently been demonstrated in association with infected penile prosthetic material. Clinically noninfected patients undergoing revision for mechanical malfunction have a surprisingly high rate of positive intraoperative cultures. After revision replacement prostheses have a higher rate of postoperative infection than first time implants. We characterized biofilm formation on penile prostheses in clinically noninfected patients undergoing revision surgery.
Ten patients undergoing revision or removal of inflatable penile prosthetic devices due to mechanical malfunction were included. Specimens from the corporeal cylinders, scrotal pump and reservoir were analyzed. Bacterial biofilm coverage was detected and characterized using confocal scanning laser microscopy.
Bacterial biofilm formation associated with multiple microorganisms was demonstrated on 8 of 10 prostheses. Biofilms consisted of gram-positive rods, cocci and fungal elements.
The degree of biofilm formation on these prosthetic devices suggests that most patients have bacterial coverage on the implant. Host mechanisms to control infection may lead to a homeostatic balance that enables biofilms to exist on the surface of the prosthesis without generating clinical infection. A critical threshold of biofilm extent may exist beyond which clinical infection may occur. These results justify further evaluation of biofilms and penile prosthesis infections. Furthermore, the findings help to explain why strategies such as mini salvage procedures to eliminate subclinical biofilms may decrease the postoperative infection risk in patients undergoing repair or replacement of penile prostheses.
生物膜是被基质包裹的细菌群体，它们相互粘附和/或粘附于植入式医疗设备的表面。生物膜的形成一直被证明与感染的阴茎假体材料有关。临床上因机械故障接受翻修手术的未感染患者术中培养阳性率出奇地高。翻修更换假体后，术后感染率高于初次植入。我们对因机械故障接受翻修手术的临床上未感染患者阴茎假体上的生物膜形成进行了特征分析。
纳入10例因机械故障接受充气式阴茎假体装置翻修或取出的患者。对阴茎海绵体、阴囊泵和贮液器的标本进行分析。使用共聚焦扫描激光显微镜检测并表征细菌生物膜覆盖情况。
10个假体中有8个显示出与多种微生物相关的细菌生物膜形成。生物膜由革兰氏阳性杆菌、球菌和真菌成分组成。
这些假体装置上生物膜形成的程度表明，大多数患者的植入物上有细菌覆盖。宿主控制感染的机制可能导致一种稳态平衡，使生物膜能够在假体表面存在而不产生临床感染。可能存在一个生物膜范围的临界阈值，超过该阈值可能会发生临床感染。这些结果证明有必要进一步评估生物膜与阴茎假体感染。此外，这些发现有助于解释为什么诸如小型挽救手术以消除亚临床生物膜等策略可能会降低接受阴茎假体修复或更换患者的术后感染风险。
