Presented by: Sromona Mukherjee Phd
Cleveland Clinic Foundation

Introduction

The artificial urinary sphincter (AUS) is an effective treatment option for stress urinary incontinence due to intrinsic sphincteric deficiency in the context of neurogenic lower urinary tract dysfunction, or following prostatectomy. A subset of AUS devices is subject to infection.

The penile prosthesis is an effective treatment option for erectile dysfunction with a long-term satisfaction of >90% for both patient and partner.  The most common type of penile prosthesis is the inflatable penile prosthesis (IPP).  Infection is among the most feared complications associated with IPP placement and is associated with significant morbidity and cost burden exceeding six times the cost of initial uncomplicated IPP placement. We sought to determine the presence of antibiotic resistance genes in these samples obtained from patients.

Materials

RT-PCR was performed on samples from 15 of the 18 AUS and 25 of 27 device biofilms IPP device following DNA extractions was performed to detect commonly found antibiotic resistance genes.

Results

,

In AUS samples, sul2 (encoding for sulfonadmide resistance) was detected in 8 of 15 (53%) biofilms. ampC (encoding for penicillin resistance) was detected in 11 of 15 (73%) biofilms. An rpoB mutation associated with rifampin resistance was detected in 8 of 15 (53%) biofilms. tetA (encoding for tetracycline resistance) was not detected in the biofilms. The fimH adhesin gene, associated with biofilm formation, was detected in 10 of 15 (67%) biofilms.

In IPP samples , Sul2 was present in 48% of samples, ampC in 92% of samples, tetA (in 12% ), rifampin resistance in 36% of samples.  The fimH adhesin gene, was detected in 48% of samples. The detection of antibiotic resistance genes or fimH gene did not differ by infection status, antibiotic use in the past 30 days, pain status, or device type.  The rpoB mutation was detected in biofilms from 35% of IPPs with minocycline/rifampin coating, 25% of IPPs with user-defined antibiotic irrigation, and 50% of malleable devices (p=0.76).  tetA was detected in biofilms from 5.9% of IPPs with rifampin/minocycline coating, 25% of IPPs with user-defined antibiotic irrigation, and 12% of malleable devices (p=0.39).

Conclusion

We hypothesize that individuals commonly exposed to antibiotics select for antibiotic resistant genes thereby reducing the effectiveness of the administered antibiotic following an infection. Knowledge of previous antibiotic history may be beneficial while administering them in case of infection with a urological device.

 

Funding

NA

Lead Authors

Glenn T. Werneburg, MD,PhD
Cleveland Clinic

Daniel Hettel, MD
Cleveland Clinic

Scott Lundy, MD
Cleveland Clinic

Ava Adler,
Cleveland Clinic

Smita De, MD
Cleveland Clinic

Raymond Rackley, MD
Cleveland Clinic

Daniel A. Shoskes, MD
Exact Sciences

Aaron W Miller, PHD
Cleveland Clinic