TY - JOUR
T1 - Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis
AU - Towe, Maxwell
AU - Huynh, Linda M.
AU - Osman, Mohamad M.
AU - El-Khatib, Farouk M.
AU - Andrianne, Robert
AU - Barton, Gregory
AU - Broderick, Gregory
AU - Burnett, Arthur L.
AU - Campbell, Jeffrey D.
AU - Clavell-Hernandez, Jonathan
AU - Connor, Jessica
AU - Gross, Martin
AU - Guillum, Ross
AU - Guise, Amy I.
AU - Hatzichristodoulou, Georgios
AU - Henry, Gerard D.
AU - Hsieh, Tung Chin
AU - Jenkins, Lawrence C.
AU - Koprowski, Christopher
AU - Lee, Kook B.
AU - Lentz, Aaron
AU - Munarriz, Ricardo M.
AU - Osmonov, Daniar
AU - Pan, Shu
AU - Parikh, Kevin
AU - Park, Sung Hun
AU - Patel, Amir S.
AU - Perito, Paul
AU - Sadeghi-Nejad, Hossein
AU - Sempels, Maxime
AU - Simhan, Jay
AU - Wang, Run
AU - Yafi, Faysal A.
N1 - Copyright © 2020 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
PY - 2020/10
Y1 - 2020/10
N2 - Background: Modern-day penile prostheses use infection retardant coating to decrease rates of postoperative infection, subsequently reducing explantation and revision rates as well. The Coloplast Titan models are dipped into antimicrobial solutions right before implantation, and the components used for dipping can be tailored toward the patient. Aim: To compare infection, explantation, and revision rates among different dipping solutions used before implantation for patients with diabetes receiving a Coloplast Titan implant. Methods: We systematically reviewed 932 patients with diabetes receiving a primary penile implant across 18 different centers from the period April 2003 to August 2018. Of those patients, 473 received a Coloplast device, whereas 459 received an AMS device. Data regarding the type of antimicrobial solution used before implantation were recorded for 468 patients receiving a Coloplast Titan, including whether or not they suffered a postoperative infection and if they underwent explantation and/or revision. Outcome rates were compared using Fisher's exact and Pearson's chi-square tests, and logistic regression modeling was performed to account for covariates. Outcomes: The main outcome measures of this study were postoperative infection, explantation, and revision rates. Results: Of the total 932 patients reviewed, 33 suffered a postoperative infection. Of 468 patients receiving Coloplast implants, there was a 3.4% infection rate. The most commonly used antibiotic combination before dipping was vancomycin + gentamicin (59.0%). There was a significantly lower rate of postoperative infection, explantation, and revision when vancomycin + gentamicin was used than those associated with the use of all other dipping solutions ([1.4% vs 6.4%; P =.004], [1.1% vs 8.3%; P <.001], and [2.5% vs 12.5; P <.001], respectively). After adjusting for age, body mass index, preoperative blood glucose level, and hemoglobin A1c, the use of other dips was an independent predictor of postoperative infection (odds ratio: 0.191; P =.049). The inclusion of rifampin in the dipping solution trended toward being a significant risk factor for infection (P =.057). Including antifungals in the dipping solution did not affect infection (P =.414), explantation (P =.421), or revision (P =.328) rates. Clinical Implications: Vancomycin + gentamicin was the most efficacious combination of antibiotics used for dipping in terms of preventing postoperative infection and subsequent explantation and revision. Strengths and Limitations: Data were sampled across multiple institutions providing a large sample that may be more representative of the population of interest. A key limitation of the study was its retrospective nature, which prevented us from controlling certain variables. Conclusion: The use of rifampin did not provide the same type of protection, possibly representing a shift in resistance patterns of common bacteria responsible for device infection. Towe M, Huynh LM, Osman MM, et al. Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis. J Sex Med 2020;17:2077–2083.
AB - Background: Modern-day penile prostheses use infection retardant coating to decrease rates of postoperative infection, subsequently reducing explantation and revision rates as well. The Coloplast Titan models are dipped into antimicrobial solutions right before implantation, and the components used for dipping can be tailored toward the patient. Aim: To compare infection, explantation, and revision rates among different dipping solutions used before implantation for patients with diabetes receiving a Coloplast Titan implant. Methods: We systematically reviewed 932 patients with diabetes receiving a primary penile implant across 18 different centers from the period April 2003 to August 2018. Of those patients, 473 received a Coloplast device, whereas 459 received an AMS device. Data regarding the type of antimicrobial solution used before implantation were recorded for 468 patients receiving a Coloplast Titan, including whether or not they suffered a postoperative infection and if they underwent explantation and/or revision. Outcome rates were compared using Fisher's exact and Pearson's chi-square tests, and logistic regression modeling was performed to account for covariates. Outcomes: The main outcome measures of this study were postoperative infection, explantation, and revision rates. Results: Of the total 932 patients reviewed, 33 suffered a postoperative infection. Of 468 patients receiving Coloplast implants, there was a 3.4% infection rate. The most commonly used antibiotic combination before dipping was vancomycin + gentamicin (59.0%). There was a significantly lower rate of postoperative infection, explantation, and revision when vancomycin + gentamicin was used than those associated with the use of all other dipping solutions ([1.4% vs 6.4%; P =.004], [1.1% vs 8.3%; P <.001], and [2.5% vs 12.5; P <.001], respectively). After adjusting for age, body mass index, preoperative blood glucose level, and hemoglobin A1c, the use of other dips was an independent predictor of postoperative infection (odds ratio: 0.191; P =.049). The inclusion of rifampin in the dipping solution trended toward being a significant risk factor for infection (P =.057). Including antifungals in the dipping solution did not affect infection (P =.414), explantation (P =.421), or revision (P =.328) rates. Clinical Implications: Vancomycin + gentamicin was the most efficacious combination of antibiotics used for dipping in terms of preventing postoperative infection and subsequent explantation and revision. Strengths and Limitations: Data were sampled across multiple institutions providing a large sample that may be more representative of the population of interest. A key limitation of the study was its retrospective nature, which prevented us from controlling certain variables. Conclusion: The use of rifampin did not provide the same type of protection, possibly representing a shift in resistance patterns of common bacteria responsible for device infection. Towe M, Huynh LM, Osman MM, et al. Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis. J Sex Med 2020;17:2077–2083.
KW - Diabetes Mellitus/drug therapy
KW - Gentamicins/therapeutic use
KW - Humans
KW - Male
KW - Penile Implantation
KW - Penile Prosthesis
KW - Retrospective Studies
UR - http://www.scopus.com/inward/record.url?scp=85089461452&partnerID=8YFLogxK
U2 - 10.1016/j.jsxm.2020.07.009
DO - 10.1016/j.jsxm.2020.07.009
M3 - Article
C2 - 32807707
AN - SCOPUS:85089461452
SN - 1743-6095
VL - 17
SP - 2077
EP - 2083
JO - Journal of Sexual Medicine
JF - Journal of Sexual Medicine
IS - 10
ER -