title: 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.
abstract: BACKGROUND
  Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. Electronic address: martin.s.gross@gmail.com.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Gross
authors.affiliation: Boston University Medical Center, Boston, MA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Phillips
authors.affiliation: Boston University Medical Center, Boston, MA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Carrasquillo
authors.affiliation: Boston University Medical Center, Boston, MA, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Thornton
authors.affiliation: Urology Associates of North Texas, Grapevine, TX, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Greenfield
authors.affiliation: Rush Medical College, Chicago, IL, USA.
authors.forename: Laurence A
authors.initials: LA
authors.lastname: Levine
authors.affiliation: NYU Langone Medical Center, New York, NY, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Alukal
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: William P
authors.initials: WP
authors.lastname: Conners
authors.affiliation: Faculdade de Medicina do ABC/Instituto H. Ellis, Bela Vista, SP, Brazil.
authors.forename: Sidney
authors.initials: S
authors.lastname: Glina
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Cigdem
authors.initials: C
authors.lastname: Tanrikut
authors.affiliation: Yale School of Medicine, New Haven, CT, USA.
authors.forename: Stanton C
authors.initials: SC
authors.lastname: Honig
authors.affiliation: University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Edgardo F
authors.initials: EF
authors.lastname: Becher
authors.affiliation: Lahey Hospital and Medical Center, Burlington, MA, USA.
authors.forename: Nelson E
authors.initials: NE
authors.lastname: Bennett
authors.affiliation: The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Run
authors.initials: R
authors.lastname: Wang
authors.affiliation: Perito Urology, Coral Gables, FL, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Perito
authors.affiliation: Columbia University College of Physicians & Surgeons, New York, NY, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Stahl
authors.affiliation: Hospital Quirón Palmaplanas Salud, Palma, Illes Balears, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Rosselló Gayá
authors.affiliation: Hospital Quirón Palmaplanas Salud, Palma, Illes Balears, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Rosselló Barbará
authors.affiliation: Urology Specialists, Hialeah, FL, USA.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Cedeno
authors.affiliation: Urology Specialists, Hialeah, FL, USA.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Gheiler
authors.affiliation: University College London Hospital, London, UK.
authors.forename: Odunayo
authors.initials: O
authors.lastname: Kalejaiye
authors.affiliation: University College London Hospital, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ralph
authors.affiliation: SIU School of Medicine, Springfield, IL, USA.
authors.forename: Tobias S
authors.initials: TS
authors.lastname: Köhler
authors.affiliation: Mount Sinai Hospital, New York, NY, USA.
authors.forename: Doron S
authors.initials: DS
authors.lastname: Stember
authors.affiliation: USF Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Rafael E
authors.initials: RE
authors.lastname: Carrion
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Pedro P
authors.initials: PP
authors.lastname: Maria
authors.affiliation: University of Utah Hospital, Salt Lake City, UT, USA.
authors.forename: William O
authors.initials: WO
authors.lastname: Brant
authors.affiliation: Hahnemann University Hospital, Philadelphia, PA, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Bickell
authors.affiliation: Hahnemann University Hospital, Philadelphia, PA, USA.
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Garber
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pineda
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
authors.affiliation: Advanced Urological Care, New York, NY, USA.
authors.forename: J Francois
authors.initials: JF
authors.lastname: Eid
authors.affiliation: Regional Urology, Shreveport, LA, USA.
authors.forename: Gerard D
authors.initials: GD
authors.lastname: Henry
authors.affiliation: Boston University Medical Center, Boston, MA, USA.
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: Munarriz
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D015917:Penile Prosthesis / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic Prophylaxis; Bacteria; Infection; Penile Prosthesis