title: Anti-infection dip suggestions for the Coloplast Titan Inflatable Penile Prosthesis in the era of the infection retardant coated implant.
abstract: BACKGROUND
  Infection is the worst complication seen with inflatable penile prosthesis (IPP). Both the American Medical Systems (AMS) and Coloplast IPP have infection retardant coatings. AMS is coated at the factory with rifampicin and minocycline (InhibiZone). The Coloplast IPP has a hydrophilic coating covalently bonded to its components that will absorb any aqueous solution before implantation and provides increased surface lubricity to decrease bacterial adherence.
  
  
  OBJECTIVE
  We tested several antibiotic dips comparing zones of inhibition (ZOI) against five commonly infecting bacteria with coated Coloplast implants. Results were compared with those ZOI created with strips of an AMS IPP precoated with InhibiZone.
  
  
  METHODS
  Pieces of sterile Coloplast Titan IPP were dipped in (i) trimethoprim/polymixin B ophthalmic solution; (ii) trimethoprim/sulfamethoxazole infusion solution; (iii) bacitracin; (iv) rifampicin/minocycline; and (v) rifampin/trimehtoprim/sulfamethoxazole. ZOI for the Titan strips and for AMS InhibiZone coated strips were tested against Staphylococcus epidermidis, Staphylococcus lugdunensis, Staphylococcus aureus, Pseudomonas, and Enterococcus.
  
  
  METHODS
  ZOIs of the Coloplast Titan for each of the medicated solutions were compared with ZOI created by undipped strips of a sterile InhibiZone coated IPP placed on plates of the identical bacteria.
  
  
  RESULTS
  All dips except bacitracin showed ZOI≥InhibiZone (P≥0.005) for most organisms. Because of broad-spectrum effectiveness, ease of handling, and cost, infusion vial of trimehtoprim/sulfamethoxazole seemed optimal at this time. If trimehtoprim/sulfamethoxazole is unavailable; the ZOI with Polytrim ophthalmic solution zones were almost as good.
  
  
  CONCLUSIONS
  The Coloplast strips when dipped in several solutions showed equal or significantly larger ZOI against commonly infecting organisms than the InhibiZone coated strips. At the present time using off the shelf trimethoprim sulfamethoxazole infusion solution seems optimum. The flexibility of choosing the drug eluting from the Coloplast device seems promising in the changing bacterial environment.
authors.affiliation: Urology, Institutes of Urologic Excellence, Indio, CA, USA.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Wilson
authors.forename: Emad A
authors.initials: EA
authors.lastname: Salem
authors.forename: William
authors.initials: W
authors.lastname: Costerton
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001414:Bacitracin / Q000627:therapeutic use; D001424:Bacterial Infections / Q000517:prevention & control; D004359:Drug Therapy, Combination; D006801:Humans; D008911:Minocycline / Q000627:therapeutic use; D019935:Penile Implantation / Q000009:adverse effects / Q000379:methods / Q000592:standards; D015917:Penile Prosthesis / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D012293:Rifampin / Q000627:therapeutic use; D014295:Trimethoprim / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D001414:Bacitracin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014295:Trimethoprim; D008911:Minocycline; D012293:Rifampin