You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy I1 Apr 2015PD26-02 A REVIEW OF MICROORGANISMS ISOLATED AT SALVAGE OR EXPLANT OF IPPS: ARE WE COVERING THE CORRECT BUGS? Martin Gross, Francois Eid, Christopher Yang, Ross Simon, Daniel Martinez, Rafael Carrion, Paul Perito, Nelson Bennett, Laurence Levine, Jason Greenfield, and Ricardo Munarriz Martin GrossMartin Gross More articles by this author , Francois EidFrancois Eid More articles by this author , Christopher YangChristopher Yang More articles by this author , Ross SimonRoss Simon More articles by this author , Daniel MartinezDaniel Martinez More articles by this author , Rafael CarrionRafael Carrion More articles by this author , Paul PeritoPaul Perito More articles by this author , Nelson BennettNelson Bennett More articles by this author , Laurence LevineLaurence Levine More articles by this author , Jason GreenfieldJason Greenfield More articles by this author , and Ricardo MunarrizRicardo Munarriz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1078AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current AUA guidelines regarding IPP implantation dictate that the standard of care is to use antibiotics that cover Gram-positive and Gram-negative organisms. Surgical prophylaxis with aminoglycosides, vancomycin, cephalosporins, and fluoroquinolones is recommended. These guidelines are intended to prevent infection with skin flora (the most likely cause of infection per the literature) and urinary tract flora. A review of organisms cultured during IPP salvage or explant at our institutions indicates that fungi and anaerobes are prevalent isolates. These organisms are not covered by the recommended antibiotic regimens. METHODS This is a retrospective multi-institution study of 65 patients with IPPs who presented with infections. These patients underwent either prosthesis explant or Mulcahy salvage procedure with device replacement. Patients' operative notes and charts were extensively reviewed to compile study data. Antibiotics were recorded at implantation, immediately prior to infection-related surgery, and during infection-related surgery. RESULTS Between 2002 and 2014 65 patients presented with IPP infection. Antibiotic regimens for all patients at implantation were consistent with current AUA guidelines. Intraoperative cultures were obtained at the time of either salvage or explant. 42 patients had at least one organism cultured from their wound at time of salvage or explant. 5 had more than one organism. Coagulase negative staph was the most commonly cultured organism, and was present in 20 isolates (31%). Candida albicans was the second most commonly cultured organism, and was present in 8 isolates (12%). Other cultured organisms included expected Gram-positive and Gram-negative flora: MRSA (5 patients, 8% of all cultures), group B strep (5, 8%), prevotella bivia (2, 3%), enterococcus (2, 3%), pseudomonas (2, 3%), staph epidermidis (1, 1.5%), and klebsiella (1, 1.5%). Anaerobes, including peptostreptococcus, clostridium innocuum, bacteroides tectus, and lactobacillus acidophilus, were individually cultured once, occurring at a rate of 1.5% each. CONCLUSIONS Intraoperative cultures obtained from infected IPPs in this sample show an unexpected rate of microorganisms that are not covered by current AUA recommended antibiotic regimens. Candida was present in 12% of cultures, and anaerobes were present in four total cultures, for a combined prevalence of 6%. Further correlation with data from other providers may verify if this trend indicates a need to broaden antifungal and antibiotic coverage at implantation, salvage, or explant. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e566 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin Gross More articles by this author Francois Eid More articles by this author Christopher Yang More articles by this author Ross Simon More articles by this author Daniel Martinez More articles by this author Rafael Carrion More articles by this author Paul Perito More articles by this author Nelson Bennett More articles by this author Laurence Levine More articles by this author Jason Greenfield More articles by this author Ricardo Munarriz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...