Division of Urology, University of Maryland, School of Medicine, Baltimore, MD, USA.
Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA.
J Sex Med. 2020 Oct;17(10):2077-2083. doi: 10.1016/j.jsxm.2020.07.009. Epub 2020 Aug 15.
Modern-day penile prostheses use infection retardant coating to decrease rates of postoperative infection, subsequently reducing explantation and revision rates as well. The Coloplast Titan models are dipped into antimicrobial solutions right before implantation, and the components used for dipping can be tailored toward the patient.
To compare infection, explantation, and revision rates among different dipping solutions used before implantation for patients with diabetes receiving a Coloplast Titan implant.
We systematically reviewed 932 patients with diabetes receiving a primary penile implant across 18 different centers from the period April 2003 to August 2018. Of those patients, 473 received a Coloplast device, whereas 459 received an AMS device. Data regarding the type of antimicrobial solution used before implantation were recorded for 468 patients receiving a Coloplast Titan, including whether or not they suffered a postoperative infection and if they underwent explantation and/or revision. Outcome rates were compared using Fisher's exact and Pearson's chi-square tests, and logistic regression modeling was performed to account for covariates.
The main outcome measures of this study were postoperative infection, explantation, and revision rates.
Of the total 932 patients reviewed, 33 suffered a postoperative infection. Of 468 patients receiving Coloplast implants, there was a 3.4% infection rate. The most commonly used antibiotic combination before dipping was vancomycin + gentamicin (59.0%). There was a significantly lower rate of postoperative infection, explantation, and revision when vancomycin + gentamicin was used than those associated with the use of all other dipping solutions ([1.4% vs 6.4%; P = .004], [1.1% vs 8.3%; P < .001], and [2.5% vs 12.5; P < .001], respectively). After adjusting for age, body mass index, preoperative blood glucose level, and hemoglobin A1c, the use of other dips was an independent predictor of postoperative infection (odds ratio: 0.191; P = .049). The inclusion of rifampin in the dipping solution trended toward being a significant risk factor for infection (P = .057). Including antifungals in the dipping solution did not affect infection (P = .414), explantation (P = .421), or revision (P = .328) rates.
Vancomycin + gentamicin was the most efficacious combination of antibiotics used for dipping in terms of preventing postoperative infection and subsequent explantation and revision.
Data were sampled across multiple institutions providing a large sample that may be more representative of the population of interest. A key limitation of the study was its retrospective nature, which prevented us from controlling certain variables.
The use of rifampin did not provide the same type of protection, possibly representing a shift in resistance patterns of common bacteria responsible for device infection. Towe M, Huynh LM, Osman MM, et al. Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis. J Sex Med 2020;17:2077-2083.
现代阴茎假体使用抗感染涂层来降低术后感染率，从而降低假体取出和翻修率。科洛普夫坦阴茎假体模型在植入前浸入抗菌溶液中，并且用于浸渍的组件可以根据患者的情况进行定制。
比较不同浸渍溶液在植入前用于接受科洛普夫坦阴茎假体植入的糖尿病患者中的感染、假体取出和翻修率。
我们系统地回顾了 2003 年 4 月至 2018 年 8 月期间 18 个不同中心的 932 名接受原发性阴茎植入术的糖尿病患者。在这些患者中，473 名患者接受了科洛普夫坦植入物，而 459 名患者接受了 AMS 植入物。记录了 468 名接受科洛普夫坦 Titan 植入物的患者在植入前使用的抗菌溶液类型的数据，包括是否发生术后感染以及是否进行了假体取出和/或翻修。使用 Fisher 精确检验和 Pearson χ2 检验比较结果率，并进行逻辑回归建模以考虑协变量。
在回顾的 932 名患者中，33 名患者发生术后感染。在 468 名接受科洛普夫坦植入物的患者中，感染率为 3.4%。最常用的抗生素组合是万古霉素+庆大霉素（59.0%）。在使用万古霉素+庆大霉素时，术后感染、假体取出和翻修的发生率明显低于使用其他所有浸渍溶液时的发生率（[1.4%比 6.4%；P=0.004]，[1.1%比 8.3%；P<0.001]，[2.5%比 12.5%；P<0.001]）。在调整年龄、体重指数、术前血糖水平和血红蛋白 A1c 后，使用其他浸渍液是术后感染的独立预测因素（优势比：0.191；P=0.049）。在浸渍液中加入利福平有感染的趋势（P=0.057）。在浸渍液中加入抗真菌药物并不会影响感染（P=0.414）、假体取出（P=0.421）或翻修（P=0.328）率。
万古霉素+庆大霉素是预防术后感染和随后的假体取出和翻修最有效的抗生素组合。
数据是从多个机构采集的，提供了一个可能更能代表目标人群的大样本。该研究的一个关键局限性是其回顾性，这使我们无法控制某些变量。
利福平的使用并没有提供相同类型的保护，这可能代表了导致设备感染的常见细菌的耐药模式发生了转变。
