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Multicenter Investigation of the Microorganisms Involved in Penile Prosthesis infection: Are the AUA and EAU Guidelines Appropriate for Penile Prosthesis Prophylaxis and Infection Management?
Martin S. Gross, MD1, Elizabeth A. Phillips, MD2, Robert J. Carrasquillo, MD3, Jason M. Greenfield, MD4, Laurence A. Levine, MD5, William P. Conners, III, MD6, Sidney Glina, MD7, Cigdem Tanrikut, MD8, Stanton C. Honig, MD9, Nelson E. Bennett, MD10, Run Wang, MD11, Paul E. Perito, MD12, Mariano Rosselló Barbará, MD13, Edward Gheiler, MD14, Tobias Köhler, MD15, Doron S. Stember, MD16, Rafael E. Carrion, MD17, Pedro Maria, MD18, William O. Brant, MD19, Bruce B. Garber, MD20, Miguel Pineda, MD21, Arthur L. Burnett, MD21, J. Francois Eid, MD22, Gerard D. Henry, MD23, Ricardo M. Munarriz, MD3.
1Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Keene, NH, USA, 2Boston University Medical Center, Boston, MD, USA, 3Boston University Medical Center, Boston, MA, USA, 4Urology Associates of North Texas, Arlington, TX, USA, 5Rush Medical College, Chicago, IL, USA, 6Beth Israel Deaconess Medical Center, Boston, MA, USA, 7Instituto H. Ellis and Hospital Ipiranga, São Paulo, Brazil, 8Masachusetts General Hospital, Boston, MA, USA, 9Yale School of Medicine, New Haven, CT, USA, 10Lahey Hospital and Medical Center, Burlington, MA, USA, 11UT Health Science Center at Houston, Houston, TX, USA, 12Perito Urology, Coral Gables, FL, USA, 13Hospital Quirón Palmaplanas Salud, Palma de Mallorca, Spain, 14Urology Specialists, Hialeah, FL, USA, 15SIU School of Medicine, Springfield, IL, USA, 16Mount Sinai Hospital, New York City, NY, USA, 17USF Morsani College of Medicine, Tampa, FL, USA, 18Albert Einstein College of Medicine, New York City, NY, USA, 19University of Utah Hospital, Salt Lake City, UT, USA, 20Hahnemann University Hospital, Philadelphia, PA, USA, 21Johns Hopkins University School of Medicine, Baltimore, MD, USA, 22Advanced Urological Care, New York City, NY, USA, 23Regional Urology, Shreveport, LA, USA.

BACKGROUND: Despite advancements in surgical technique, device improvements and adoptions of antibiotic prophylaxis guidelines, penile prosthesis infections continue to be a significant problem. The aim of this study was to investigate the microbiology of penile prosthesis infections to better understand and ultimately decrease infection rates.
METHODS: This is a retrospective IRB-exempt multi-institution study of 200 patients with infected IPPs from who underwent explant or Mulcahy salvage procedure with device replacement. Intraoperative cultures were obtained in all cases. Antibiotics were recorded at implantation, preoperative hospitalization, and surgery.
RESULTS: Between 2002 and 2015, 200 intraoperative cultures were obtained at the time of salvage or explant. Antibiotic regimens for all patients at implantation were generally consistent with AUA guidelines. No culture growth occurred in 35% of cases and gram-positive and negative organisms were found in 49% and 20.5% of cultures respectively. In addition, candida species and anaerobes were identified in 8% and 7.5% of total cultures respectively. Candida species (12.3%) and anaerobes (11.5%) comprised nearly one quarter of 130 positive cultures. Ten percent of 130 positive cultures showed MRSA infections. Antibiotic choices at preoperative hospitalization and salvage or explant surgery were widely varied compared to those at IPP implantation.
CONCLUSIONS: Our study documented a high incidence of anaerobic and candida infections, which are not covered by current antibiotic prophylaxis guidelines. In addition, over 1/3 of penile prosthesis cases had negative cultures. These findings suggest a need to broaden antibiotic prophylaxis from current guidelines as well as create a management algorithm for penile prosthesis infections.


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