Chandrapal Jason, Harper Shelby, Davis Leah G, Lentz Aaron C
Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Center Biostatistics, Duke University Medical Center, Durham, NC, USA.
Sex Med. 2020 Dec;8(4):783-787. doi: 10.1016/j.esxm.2020.06.006. Epub 2020 Jul 14.
Infection rates for virgin inflatable penile prostheses (IPPs) range from 1 to 3%; however, this can increase to 7-18% after IPP revision or removal/replacement (RR) for mechanical malfunction. Although studies have reported various RR and salvage cultures, limited data are available that directly compare microorganisms after each of these procedures within the same patient. Comparison of these cultures may determine if the infection is due to a persistent microorganism or new inoculation.
Our aim is to characterize prosthesis cultures within individual patients who develop infection after RR.
We retrospectively reviewed patients undergoing various IPP procedures at our institution from September 2002 to August 2018. RR procedures were determined by current procedural terminology codes 54,410 or 54,416. Infection, defined as salvage or explantation without replacement for infectious reasons, was described by current procedural terminology codes 54406, 54411, 54415, or 54417. Inclusion criteria consisted of IPP infection after RR and the presence of both RR and salvage cultures within the same patient. Owing to the small cohort size, only descriptive statistics were used.
Characterization of removal/replacement and salvage cultures is the main outcome measure of this study.
A total of 202 non-infected RR procedures were performed with 9 cases (4%) of IPP infection after RR identified. Four (44%) of the RR cultures were positive and contained gram-positive (44%) and gram-negative (11%) organisms. In comparison, salvage cultures grew gram-positive bacteria (66%), gram-negative bacteria (33%), and/or fungal elements (33%). A direct comparison of the RR and salvage cultures indicated that only 2 patients (22%) grew similar organisms.
The risk of IPP infection after RR and modified washout is low. In this small series, gram-positive bacteria were most common at the time of RR and salvage. The increased incidence of fungal infections may indicate a need to modify RR protocols. Larger multi-institutional studies are needed to further investigate this relationship. Chandrapal J, Harper S, Davis LG, et al. Comparison of Penile Prosthesis Cultures Within Individual Patients After Removal/Replacement and Subsequent Salvage. Sex Med 2020;8:783-787.
初次使用的可膨胀阴茎假体（IPP）感染率为1%至3%；然而，因机械故障进行IPP翻修或移除/更换（RR）后，感染率可能会升至7%至18%。尽管已有研究报告了各种RR及挽救性培养情况，但在同一患者体内直接比较这些操作后微生物的可用数据有限。比较这些培养结果可能有助于确定感染是由持续存在的微生物还是新的接种引起的。
我们的目的是对RR后发生感染的个体患者的假体培养物进行特征分析。
我们回顾性分析了2002年9月至2018年8月在我院接受各种IPP手术的患者。RR手术通过当前手术操作术语编码54410或54416确定。感染定义为因感染原因进行挽救性手术或取出假体而不进行更换，通过当前手术操作术语编码54406、54411、54415或54417描述。纳入标准包括RR后IPP感染以及同一患者同时存在RR和挽救性培养结果。由于队列规模较小，仅使用了描述性统计方法。
本研究的主要观察指标是对移除/更换及挽救性培养物进行特征分析。
共进行了202例未感染的RR手术，其中9例（4%）在RR后发生IPP感染。RR培养物中有4例（44%）呈阳性，包含革兰氏阳性菌（44%）和革兰氏阴性菌（11%）。相比之下，挽救性培养物培养出革兰氏阳性菌（66%）、革兰氏阴性菌（33%）和/或真菌成分（33%）。RR培养物与挽救性培养物的直接比较表明，只有2例患者（22%）培养出相似的微生物。
RR及改良冲洗后IPP感染的风险较低。在这个小样本系列中，RR及挽救时革兰氏阳性菌最为常见。真菌感染发生率的增加可能表明需要修改RR方案。需要开展更大规模的多机构研究来进一步探究这种关系。钱德拉帕尔J、哈珀S、戴维斯LG等。个体患者移除/更换及后续挽救后阴茎假体培养物的比较。性医学2020；8：783 - 787。
