(277) CHLORHEXIDINE JET LAVAGE AND CONVENTIONAL ANTIMICROBIAL SOLUTIONS IN IPP SURGERY: SIMILAR EXPLANT RATE BUT DIFFERENT INFLAMMATORY RESPONSE
Authors: Ljubetic BM , Roth B , Bole R , Lundy SD , Bajic P 
Published: December 2024

Abstract

Introduction
Infection remains a significant concern in inflatable penile prosthesis (IPP) surgery. Chlorhexidine gluconate jet lavage has seen increasing use as an intraoperative antimicrobial irrigation solution and dip for hydrophilic implants, and has been proposed as a measure to mitigate postoperative infections. However, the data supporting its effectiveness in reducing infection rates remains mixed.

Objective
This study aims to investigate the association between the use of this solution and its effect on infection relative to traditional antimicrobials during IPP implantation at a high-volume academic practice.

Methods
A retrospective analysis was conducted on data from patients who underwent IPP surgery from a single surgeon at a tertiary care center from 2020 to 2023. Patient records were reviewed to identify those who had suspected or confirmed postoperative IPP infection. The incidence of postoperative explant due to infection was recorded and compared between patients who received chlorhexidine irrigation and dip and those who received conventional antimicrobials (rifampin, gentamicin +/- amphotericin B irrigation, and rifampin + gentamicin dip for hydrophilic implants). Postoperative inflammatory markers including white blood count (WBC), C-reactive protein (CRP), and procalcitonin were also assessed in postoperative patients who experienced persistent pain or inflammation beyond the normal expected postoperative course and were compared between groups. Statistical analysis was done using RStudio. Fisher’s exact test was employed to calculate p-value.

Results
Of 207 patients who underwent IPP during the study period, 46% (n = 95) received chlorhexidine lavage and dip and 54% (n = 112) received conventional antimicrobial solution. Of the 207 patients, 10% (n = 21) exhibited at least one exam finding or pain concerning for possible device infection and 2.4% (n = 5) required IPP explant. We found that among the patients suspected for possible infection, 12.6% (n = 12) had received chlorhexidine solution compared to 8% (n = 9) of the conventional antimicrobial group (p = 0.35). Explant rates overall for infection were 3.2% for the chlorhexidine group compared to 1.8% for the conventional antibiotic (p = 0.66). In the subgroup of patients suspected of infection (n = 21), there was no statistically significant difference in the elevation of WBC, CRP and procalcitonin between those treated with chlorhexidine lavage and dip and those treated with the conventional antimicrobials (p = 0.27, p = 0.27, p = 0.24) (table 1.)

Conclusions
In our single-center cohort of patients undergoing IPP, use of chlorhexidine lavage and dip was associated with a comparable rate of infections and postoperative inflammatory findings compared to conventional antimicrobials. Given the relatively low rate of infections, larger, prospective multi-center studies are needed to better evaluate the safety and efficacy of chlorhexidine solution for preventing postoperative IPP infection.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.