Abstract
Abstract Introduction Penile prosthesis infection (PPI) remains a serious complication for men undergoing implant surgery with potentially devastating sequelae. Historically, PPI were noted to be predominantly gram-positive, such as coagulase-negative Staphylococcus species. More recently, top 3 PPI-isolated pathogens identified were Escherichia coli (18.3%), coagulase-negative Staphylococcus species (15%), and Candida (11.1%). Fear that inhibizone and liberal use of broad-spectrum antibiotics may be contributing to a new PPI organism profile and resistance patterns, antiseptic solutions have recently re-emerged. Irrisept is an FDA-approved off-the-shelf product, containing 0.05% chlorhexidine gluconate (CHG), has recently been heavily marketed. Promising in-vitro results have swayed some implanting surgeons to change their practice. Objective To detail our experience and results after completely switching to Irrisept during virgin IPP implantation. Methods This is a retrospective review of primary IPP cases that were performed by one surgeon in the same outpatient center. Between September and November 2023, Irrisept completely substituted the usual solution of Gentamicin, Vancomycin and Amphotericin B or Fluconazole for both device “dipping” and intraoperative irrigation. All other procedures, including pre-operative scrub and IV antibiotics on induction, remained unchanged. The outcomes of these patients were compared to those undergoing primary IPP in the preceding 9 months when the routine protocol was used (November 2022 – August 2023). Presented outcomes represent follow-up from date of primary implant to 31st May 2024. Results In the 3 months that Irrisept was used, 60 primary implants were performed and two became infected (3.3%). Both manifested with pain and purulent exudate egress from their infrapubic wounds. Both underwent successful salvage to malleable prosthesis. Only one case yielded a positive wound culture, growing Klebsiella pneumoniae (pan-sensitive, except to Ampicillin). In contrast, 243 primary implants were performed in the 9 months prior without any infection (0%). Conclusions The in-vitro claims of Irrisept, with respect to Kinetic-Kill Time and logarithmic reduction in bacterial/fungal colony counts, did not translate to our in-vivo experience. Further multicenter studies are necessary to interrogate the use of this product in prosthetic urology. Disclosure No.
Published Version
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