Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis

Martin S. Gross, Elizabeth A. Phillips, Robert J. Carrasquillo, Amanda Thornton, Jason M. Greenfield, Laurence A. Levine, Joseph P. Alukal, William P. Conners, Sidney Glina, Cigdem Tanrikut, Stanton C. Honig, Edgardo F. Becher, Nelson E. Bennett, Run Wang, Paul E. Perito, Peter J. Stahl, Mariano Rosselló Gayá, Mariano Rosselló Barbará, Juan D. Cedeno, Edward L. GheilerOdunayo Kalejaiye, David J. Ralph, Tobias S. Köhler, Doron S. Stember, Rafael E. Carrion, Pedro P. Maria, William O. Brant, Michael W. Bickell, Bruce B. Garber, Miguel Pineda, Arthur Burnett, J. Francois Eid, Gerard D. Henry, Ricardo M. Munarriz

Research output: Contribution to journalArticle

Abstract

Introduction Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines. Aim To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections. Methods This retrospective institutional review board–exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device. Main Outcome Measures Intraoperative culture data from infected IPPs. Results Two hundred twenty-seven intraoperative cultures (2002–2016) were obtained at salvage or explantation. No culture growth occurred in 33% of cases and gram-positive and gram-negative organisms were found in 73% and 39% of positive cultures, respectively. Candida species (11.1%), anaerobes (10.5%) and methicillin-resistant Staphylococcus aureus (9.2%) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25% of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62% to 86% of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation. Conclusion This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success. Gross MS, Phillips EA, Carrasquillo RJ, et al. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017;14:455–463.

Original languageEnglish (US)
Pages (from-to)455-463
Number of pages9
JournalJournal of Sexual Medicine
Volume14
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Penile Prosthesis
Urology
Guidelines
Infection
Antibiotic Prophylaxis
Anti-Bacterial Agents
Candida
Penile Implantation
Equipment and Supplies
Methicillin Resistance
Methicillin-Resistant Staphylococcus aureus
Biofilms
Microbiology

Keywords

  • Antibiotic Prophylaxis
  • Bacteria
  • Infection
  • Penile Prosthesis

ASJC Scopus subject areas

  • Medicine(all)
  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Urology

Cite this

Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection : An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. / Gross, Martin S.; Phillips, Elizabeth A.; Carrasquillo, Robert J.; Thornton, Amanda; Greenfield, Jason M.; Levine, Laurence A.; Alukal, Joseph P.; Conners, William P.; Glina, Sidney; Tanrikut, Cigdem; Honig, Stanton C.; Becher, Edgardo F.; Bennett, Nelson E.; Wang, Run; Perito, Paul E.; Stahl, Peter J.; Rosselló Gayá, Mariano; Rosselló Barbará, Mariano; Cedeno, Juan D.; Gheiler, Edward L.; Kalejaiye, Odunayo; Ralph, David J.; Köhler, Tobias S.; Stember, Doron S.; Carrion, Rafael E.; Maria, Pedro P.; Brant, William O.; Bickell, Michael W.; Garber, Bruce B.; Pineda, Miguel; Burnett, Arthur; Eid, J. Francois; Henry, Gerard D.; Munarriz, Ricardo M.

In: Journal of Sexual Medicine, Vol. 14, No. 3, 01.03.2017, p. 455-463.

Research output: Contribution to journalArticle

Gross, MS, Phillips, EA, Carrasquillo, RJ, Thornton, A, Greenfield, JM, Levine, LA, Alukal, JP, Conners, WP, Glina, S, Tanrikut, C, Honig, SC, Becher, EF, Bennett, NE, Wang, R, Perito, PE, Stahl, PJ, Rosselló Gayá, M, Rosselló Barbará, M, Cedeno, JD, Gheiler, EL, Kalejaiye, O, Ralph, DJ, Köhler, TS, Stember, DS, Carrion, RE, Maria, PP, Brant, WO, Bickell, MW, Garber, BB, Pineda, M, Burnett, A, Eid, JF, Henry, GD & Munarriz, RM 2017, 'Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis', Journal of Sexual Medicine, vol. 14, no. 3, pp. 455-463. https://doi.org/10.1016/j.jsxm.2017.01.007
Gross, Martin S. ; Phillips, Elizabeth A. ; Carrasquillo, Robert J. ; Thornton, Amanda ; Greenfield, Jason M. ; Levine, Laurence A. ; Alukal, Joseph P. ; Conners, William P. ; Glina, Sidney ; Tanrikut, Cigdem ; Honig, Stanton C. ; Becher, Edgardo F. ; Bennett, Nelson E. ; Wang, Run ; Perito, Paul E. ; Stahl, Peter J. ; Rosselló Gayá, Mariano ; Rosselló Barbará, Mariano ; Cedeno, Juan D. ; Gheiler, Edward L. ; Kalejaiye, Odunayo ; Ralph, David J. ; Köhler, Tobias S. ; Stember, Doron S. ; Carrion, Rafael E. ; Maria, Pedro P. ; Brant, William O. ; Bickell, Michael W. ; Garber, Bruce B. ; Pineda, Miguel ; Burnett, Arthur ; Eid, J. Francois ; Henry, Gerard D. ; Munarriz, Ricardo M. / Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection : An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. In: Journal of Sexual Medicine. 2017 ; Vol. 14, No. 3. pp. 455-463.
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abstract = "Introduction Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines. Aim To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections. Methods This retrospective institutional review board–exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device. Main Outcome Measures Intraoperative culture data from infected IPPs. Results Two hundred twenty-seven intraoperative cultures (2002–2016) were obtained at salvage or explantation. No culture growth occurred in 33{\%} of cases and gram-positive and gram-negative organisms were found in 73{\%} and 39{\%} of positive cultures, respectively. Candida species (11.1{\%}), anaerobes (10.5{\%}) and methicillin-resistant Staphylococcus aureus (9.2{\%}) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25{\%} of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62{\%} to 86{\%} of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation. Conclusion This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14{\%} to 38{\%} of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success. Gross MS, Phillips EA, Carrasquillo RJ, et al. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017;14:455–463.",
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TY - JOUR

T1 - Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection

T2 - An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis

AU - Gross, Martin S.

AU - Phillips, Elizabeth A.

AU - Carrasquillo, Robert J.

AU - Thornton, Amanda

AU - Greenfield, Jason M.

AU - Levine, Laurence A.

AU - Alukal, Joseph P.

AU - Conners, William P.

AU - Glina, Sidney

AU - Tanrikut, Cigdem

AU - Honig, Stanton C.

AU - Becher, Edgardo F.

AU - Bennett, Nelson E.

AU - Wang, Run

AU - Perito, Paul E.

AU - Stahl, Peter J.

AU - Rosselló Gayá, Mariano

AU - Rosselló Barbará, Mariano

AU - Cedeno, Juan D.

AU - Gheiler, Edward L.

AU - Kalejaiye, Odunayo

AU - Ralph, David J.

AU - Köhler, Tobias S.

AU - Stember, Doron S.

AU - Carrion, Rafael E.

AU - Maria, Pedro P.

AU - Brant, William O.

AU - Bickell, Michael W.

AU - Garber, Bruce B.

AU - Pineda, Miguel

AU - Burnett, Arthur

AU - Eid, J. Francois

AU - Henry, Gerard D.

AU - Munarriz, Ricardo M.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Introduction Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines. Aim To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections. Methods This retrospective institutional review board–exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device. Main Outcome Measures Intraoperative culture data from infected IPPs. Results Two hundred twenty-seven intraoperative cultures (2002–2016) were obtained at salvage or explantation. No culture growth occurred in 33% of cases and gram-positive and gram-negative organisms were found in 73% and 39% of positive cultures, respectively. Candida species (11.1%), anaerobes (10.5%) and methicillin-resistant Staphylococcus aureus (9.2%) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25% of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62% to 86% of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation. Conclusion This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success. Gross MS, Phillips EA, Carrasquillo RJ, et al. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017;14:455–463.

AB - Introduction Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines. Aim To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections. Methods This retrospective institutional review board–exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device. Main Outcome Measures Intraoperative culture data from infected IPPs. Results Two hundred twenty-seven intraoperative cultures (2002–2016) were obtained at salvage or explantation. No culture growth occurred in 33% of cases and gram-positive and gram-negative organisms were found in 73% and 39% of positive cultures, respectively. Candida species (11.1%), anaerobes (10.5%) and methicillin-resistant Staphylococcus aureus (9.2%) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25% of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62% to 86% of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation. Conclusion This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success. Gross MS, Phillips EA, Carrasquillo RJ, et al. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017;14:455–463.

KW - Antibiotic Prophylaxis

KW - Bacteria

KW - Infection

KW - Penile Prosthesis

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