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AUA 2011 - Panel discussion: Antimicrobial prophylaxis for genitourinary prosthetics - Session Highlights

WASHINGTON, DC USA (UroToday.com) - Lawrence Hakim noted that there are 30,000 GU prosthesis (IPP, AUS and slings) implanted each year. The risk of infection is high and it has changed little in the past 4 decades. If an infection occurs, the organism is most likely to be resistant staph aureus (e.g. MRSA). Infections increase risks of mortality and morbidity. A cause of resistant bacteria is biofilms which develop on the surface of the device. Ways to reduce infection include
  1. pre-op antiseptic showering,
  2. pre-op staph screening with treatment if found,
  3. pre-op shaving however, if performed the night before, this can increase risk of infection so recommend shaving be performed immediately prior to procedure,
  4. pre-op hand scrub,
  5. skin prep using chorihexidine alcohol cleansing.

He cited research that showed that preoperative cleansing of the patient's skin with chlorhexidine-alcohol was superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery. (Darouiche et.al. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. N Engl J Med. 2010. 362(1):18-26). The OR environment that promotes air flow may be beneficial as it moves particles away from the surgical area. But good surgical technique is the most important way to prevent infection when implanting a GU prosthesis.

He then reviewed the recommendations form the AUA best practice statement on use of antimicrobial prophylaxis in urologic surgery (Wolf, et.al., Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008. 179(4):1379-90). Diabetes evidently does not increase the risk of prosthesis infection, High volume surgeons have lower implant infection rates.

Dr. Carson then presented information on the use of prostheses impregnated with antibiotic. He reviewed the Inhibizone which is an antibiotic coated AMS 700 series prosthesis. It has been shown to be most effective against staph and has shown durability over time. The Coloplast Alpha 1 and Titan is a prosthesis that requires it be soaked in an antibiotic (e.g. Bactrim) prior to insertion. These different types of models seem to have the best record for preventing infections in IPPs. This panel’s recommendation is that antibiotic coating/impregnation is the preferred implant in 2011.

 

References:
Dhabuwala et.al. Infection rates of rifampin/gentamicin-coated Titan Coloplast penile implants. Comparison with Inhibizone-impregnated AMS penile implants. J Sex Med. 2011. 8(1):315-20.
McKim & Carson AMS 700 inflatable penile prosthesis with InhibiZone. Expert Rev Med Devices. 2010. 7(3):311-7.
Mansouri, et al., Comparative assessment of antimicrobial activities of antibiotic-treated penile prostheses. Eur Urol. 2009. 56(6):1039-45.
Wosnitzer & Greenfield. Antibiotic patterns with inflatable penile prosthesis insertion. J Sex Med. 2011. 8(5):1521-8.

 

 

Panelists: Culley Carson III and Lawrence Hakim

Moderated by Chirpriya Dhabuwala, MD at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA


Reported for UroToday by Diane K. Newman, RNC, MSN, CRNP, FAAN and Continence Nurse Practitioner Specialist - University of Pennsylvania Medical Center.

 


 

The opinions expressed in this article are those of the UroToday.com Contributing Editor and do not necessarily reflect the viewpoints of the American Urological Association.


 

 



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