Kavoussi Nicholas L, Siegel Jordan A, Viers Boyd R, Pagliara Travis J, Hofer Matthias D, Cordon Billy H, Shakir Nabeel, Scott Jeremy M, Morey Allen F
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Sex Med. 2017 Jan;14(1):163-168. doi: 10.1016/j.jsxm.2016.10.017.
Although preoperative negative urine culture results and treatment of urinary tract infections are generally advised before artificial urinary sphincter (AUS) and penile prosthesis (PP) surgery to prevent device infection, limited evidence exists to support this practice.
To evaluate the relation between preoperative urine culture results and the bacteriology of prosthetic device infections.
Men undergoing AUS and/or PP placement at a tertiary referral center from 2007 through 2015 were analyzed. A total of 713 devices were implanted in 681 patients (337 AUSs in 314 patients and 376 PPs in 367 patients), of whom 259 (36%) did not have preoperative urine culture and were excluded. The remaining 454 patients received standard broad-spectrum perioperative antibiotics. Two patient groups were identified based on preoperative urine cultures: group 1 had negative urine culture results and group 2 had untreated asymptomatic positive urine culture results identified postoperatively.
Device infection was diagnosed clinically and cultures obtained from the explanted device and tissue spaces were compared with preoperative urine culture results.
Although multivariate analysis showed that patients undergoing AUS placement had a 4.5-fold greater risk of positive urine culture results (114 of 250, 45%) compared with those undergoing PP placement (36 of 204, 18%; P < .001), infection rates between device types were similar (8 of 250 for AUSs [3%] and 7 of 204 for PPs [3%]; P = .89). At a median follow-up of 15 months, device infection occurred in 15 of 454 devices (3%) implanted and no differences in infection rates were noted between urine culture groups (10 of 337 in group 1 [3.3%] and 5 of 117 in group 2 [4.3%]; P = .28). Remarkably, only 1 of 15 device infections (7%) had the same organism present at preoperative urine culture.
Despite the finding that patients with AUS placement had a 4.5 times higher rate of positive urine culture results than patients with PP placement, preoperative urine culture results appeared to show little correlation with the bacteriology of prosthetic device infections.
尽管一般建议在人工尿道括约肌（AUS）和阴茎假体（PP）手术前进行尿培养结果阴性及治疗尿路感染以预防器械感染，但支持这种做法的证据有限。
评估术前尿培养结果与假体器械感染细菌学之间的关系。
对2007年至2015年在一家三级转诊中心接受AUS和/或PP植入的男性进行分析。共681例患者植入了713个器械（314例患者植入337个AUS，367例患者植入376个PP），其中259例（36%）未进行术前尿培养，被排除在外。其余454例患者接受了标准的围手术期广谱抗生素治疗。根据术前尿培养结果确定了两个患者组：第1组尿培养结果为阴性，第2组术后发现无症状的尿培养结果为阳性且未治疗。
通过临床诊断器械感染，并将取出的器械和组织间隙的培养结果与术前尿培养结果进行比较。
尽管多因素分析显示，与接受PP植入的患者相比，接受AUS植入的患者尿培养结果为阳性的风险高4.5倍（250例中的114例，45%）（204例中的36例，18%；P <.001），但不同器械类型的感染率相似（AUS为250例中的8例[3%]，PP为204例中的7例[3%]；P =.89）。在中位随访15个月时，454个植入器械中有15个（3%）发生器械感染，尿培养组之间的感染率无差异（第1组337例中的10例[3.3%]，第2组117例中的5例[4.3%]；P =.28）。值得注意的是，15例器械感染中只有1例（7%）术前尿培养中有相同的病原体。
尽管发现接受AUS植入的患者尿培养结果为阳性率比接受PP植入的患者高4.5倍，但术前尿培养结果似乎与假体器械感染的细菌学相关性很小。
