Bole Md Raevti, Habashy Md Engy, Yang Md David, Ahmed MBBCh Mohamed, Trost Md Landon, Ziegelmann Md Matthew, Helo Md Sevann, Kohler Md Tobias
Department of Urology, Mayo Clinic, Rochester, MN 55905, United States.
Male Fertility and Peyronie's Clinic, Orem, UT 84057, United States.
J Sex Med. 2023 Jan 14;20(1):107-112. doi: 10.1093/jsxmed/qdac001.
The advent of antibiotic-coated devices has reduced the rate of inflatable penile prosthesis (IPP) infections; however, this may have altered microbial profiles when infections do occur.
To describe the timing and causative organisms behind infection of infection retardant-coated IPPs in the context of our institution's perioperative antimicrobial protocols.
We retrospectively reviewed all patients undergoing IPP placement at our institution from January 2014 to January 2022. In all patients, perioperative antibiotic administration was congruent with American Urological Association guidelines. Boston Scientific devices are impregnated with InhibiZone (rifampin and minocycline), and all Coloplast devices were soaked in rifampin and gentamicin. Intraoperative irrigation was performed with betadine 5% irrigation prior to November 2016 and with vancomycin-gentamicin solution afterward. Cases involving prosthesis infection were identified, and variables were extracted from the medical record. Descriptive and comparative statistics were tabulated to identify clinical characteristics, including patient comorbidities, prophylaxis regimen, symptom onset, and intraoperative culture result. We previously reported an increased infection risk with Betadine irrigation and stratified results accordingly.
The primary outcome was time to infectious symptoms, while the secondary outcome was description of device cultures at the time of explantation.
A total of 1071 patients underwent IPP placement over 8 years with an overall infection rate of 2.6% (28/1071). After discontinuation of Betadine, the overall infection rate was significantly lower at 0.9% (8/919) with a relative risk of 16.9 with Betadine (P < .0001). Primary procedures represented 46.4% (13/28). Of 28 patients with infection, only 1 had no identified risk factors; the remainder included Betadine at 71% (20/28), revision/salvage procedure at 53.6% (15/28), and diabetes at 50% (14/28). Median time to symptoms was 36 days (IQR, 26-52); almost 30% of patients had systemic symptoms. Organisms with high virulence, or ability to cause disease, were found in 90.5% (19/21) of positive cultures.
Our study revealed a median time to symptoms of just over 1 month. Risk factors for infection were Betadine 5% irrigation, diabetes, and revision/salvage cases. Over 90% causative organisms were virulent, demonstrating a microbial profile trend since antibiotic coating development.
The large prospectively maintained database is a strength along with the ability to follow specific changes in perioperative protocols. The retrospective nature of the study is a limitation as well as the low infection rate, which limits certain subanalyses from being performed.
IPP infections present in a delayed manner despite the rising virulence of infecting organisms. These findings highlight areas for improvement in perioperative protocols in the contemporary prosthetics era.
抗生素涂层装置的出现降低了可膨胀阴茎假体（IPP）感染率；然而，当感染发生时，这可能改变了微生物谱。
在我们机构围手术期抗菌方案的背景下，描述抗感染涂层IPP感染的时间和致病微生物。
我们回顾性分析了2014年1月至2022年1月在我们机构接受IPP植入的所有患者。所有患者围手术期抗生素给药均符合美国泌尿外科学会指南。波士顿科学公司的装置浸渍有InhibiZone（利福平和米诺环素），所有康乐保公司的装置均浸泡在利福平和庆大霉素中。2016年11月之前术中用5%碘伏冲洗，之后用万古霉素-庆大霉素溶液冲洗。确定涉及假体感染的病例，并从病历中提取变量。列出描述性和比较性统计数据以确定临床特征，包括患者合并症、预防方案、症状发作和术中培养结果。我们之前报告了碘伏冲洗增加感染风险并相应地分层了结果。
主要结果是出现感染症状的时间，次要结果是取出时装置培养物的描述。
8年间共有1071例患者接受IPP植入，总体感染率为2.6%（28/1071）。停用碘伏后，总体感染率显著降低至0.9%（8/919），碘伏相关相对风险为16.9（P＜0.0001）。初次手术占46.4%（13/28）。在28例感染患者中，只有1例未发现危险因素；其余包括71%（20/28）使用碘伏、53.6%（15/28）进行翻修/挽救手术和50%（14/28）患有糖尿病。症状出现的中位时间为36天（四分位间距，26 - 52天）；近30%的患者有全身症状。在90.5%（19/21）的阳性培养物中发现了具有高毒力或致病能力的微生物。
我们的研究显示症状出现的中位时间略超过1个月。感染的危险因素是5%碘伏冲洗、糖尿病和翻修/挽救病例。超过90%的致病微生物具有毒力，显示出自抗生素涂层发展以来的微生物谱趋势。
前瞻性维护的大型数据库是一个优点，同时能够跟踪围手术期方案的具体变化。研究的回顾性性质是一个局限性，以及低感染率，这限制了某些亚分析的进行。
尽管感染微生物的毒力不断上升，但IPP感染仍以延迟方式出现。这些发现突出了当代假体时代围手术期方案中需要改进的领域。
