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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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