Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States.
J Sex Med. 2023 Nov 30;20(12):1431-1439. doi: 10.1093/jsxmed/qdad124.
Culture-based studies have shown that penile prostheses harbor biofilms in the presence and absence of infection, but these findings have not been adequately validated using contemporary microbiome analytic techniques.
The study sought to characterize microbial biofilms of indwelling penile prosthesis devices according to patient factors, device components, manufacturer, and infection status.
Upon penile prostheses surgical explantation, device biofilms were extracted, sonicated, and characterized using shotgun metagenomics and culture-based approaches. Device components were also analyzed using scanning electron microscopy.
Outcomes included the presence or absence of biofilms, alpha and beta diversity, specific microbes identified and the presence of biofilm, and antibiotic resistance genes on each prosthesis component.
The average age of participants from whom devices were explanted was 61 ± 11 years, and 9 (45%) of 20 had a diagnosis of diabetes mellitus. Seventeen devices were noninfected, and 3 were associated with clinical infection. Mean device indwelling time prior to explant was 5.1 ± 5.1 years. All analyzed components from 20 devices had detectable microbial biofilms, both in the presence and absence of infection. Scanning electron microscopy corroborated the presence of biofilms across device components. Significant differences between viruses, prokaryotes, and metabolic pathways were identified between individual patients, device manufacturers, and infection status. Mobiluncus curtisii was enriched in manufacturer A device biofilms relative to manufacturer B device biofilms. Bordetella bronchialis, Methylomicrobium alcaliphilum, Pseudoxanthomonas suwonensis, and Porphyrobacter sp. were enriched in manufacturer B devices relative to manufacturer A devices. The most abundant bacterial phyla were the Proteobacteria, Actinobacteria, and Firmicutes. Glycogenesis, the process of glycogen synthesis, was among the predominant metabolic pathways detected across device components. Beta diversity of bacteria, viruses, protozoa, and pathways did not differ among device components.
All components of all penile prostheses removed from infected and noninfected patients have biofilms. The significance of biofilms on noninfected devices remains unknown and merits further investigation.
Strengths include the multipronged approach to characterize biofilms and being the first study to include all components of penile prostheses in tandem. Limitations include the relatively few number of infected devices in the series, a relatively small subset of devices included in shotgun metagenomics analysis, and the lack of anaerobic and other expanded conditions for culture.
Penile prosthesis biofilms are apparent in the presence and absence of infection, and the composition of biofilms was driven primarily by device manufacturer, individual variability, and infection, while being less impacted by device component.
基于培养的研究表明，在感染和非感染的情况下，阴茎假体中都存在生物膜，但这些发现尚未通过现代微生物组分析技术得到充分验证。
本研究旨在根据患者因素、器械部件、制造商和感染状态，描述留置阴茎假体装置的微生物生物膜特征。
在阴茎假体手术取出后，提取、超声处理设备生物膜，并采用高通量宏基因组学和基于培养的方法进行分析。还使用扫描电子显微镜分析设备部件。
从取出器械的患者中，平均年龄为 61±11 岁，20 人中 9 人（45%）患有糖尿病。17 个器械未感染，3 个与临床感染有关。在取出前，器械平均留置时间为 5.1±5.1 年。20 个器械的所有分析部件均检测到微生物生物膜，无论是否存在感染。扫描电子显微镜证实了器械部件上生物膜的存在。个体患者、器械制造商和感染状态之间在病毒、原核生物和代谢途径方面存在显著差异。与制造商 B 器械生物膜相比，Mobiluncus curtisii 在制造商 A 器械生物膜中富集。与制造商 A 器械相比，Bordetella bronchialis、Methylomicrobium alcaliphilum、Pseudoxanthomonas suwonensis 和 Porphyrobacter sp. 在制造商 B 器械中富集。最丰富的细菌门是变形菌门、放线菌门和厚壁菌门。糖生成，即糖原合成的过程，是在器械部件中检测到的主要代谢途径之一。细菌、病毒、原生动物和途径的β多样性在器械部件之间没有差异。
从感染和非感染患者中取出的所有阴茎假体的所有部件都有生物膜。非感染器械上生物膜的意义尚不清楚，值得进一步研究。
优势包括采用多管齐下的方法来描述生物膜，并成为第一项同时包括阴茎假体所有部件的研究。局限性包括该系列中感染器械的数量相对较少、高通量宏基因组学分析中包含的设备数量相对较少，以及缺乏厌氧和其他扩展培养条件。
阴茎假体生物膜在感染和非感染情况下均存在，生物膜的组成主要由器械制造商、个体差异和感染驱动，而受器械部件的影响较小。
