(044) Does Time of Intraoperative Exposure to the Aerobiome Increase Microbial Growth on Inflatable Penile Prostheses?
Authors: Madhusoodanan V , Suarez Arbelaez MC , Hernandez B , Towe M , Ramasamy R 
Published: February 2024

Abstract

Introduction
The use of inflatable penile prostheses (IPP) is a fundamental approach in managing erectile dysfunction that does not respond to medical management. Approximately 28,000 IPPs are implanted annually in the United States. Device infection, with an incidence up to 3%, is a particularly concerning complication as management generally necessitates device removal. This can result in significant cost burden, requiring inpatient admission, return to operative room and extensive postoperative care. One important risk factor for IPP infection is operative time, with the suggestion that increased operative time facilitates a colonization of microbes from the skin flora and ambient air within the operating room (referred to as the aerobiome).

Objective
To evaluate whether increased exposure to the operating room (OR) aerobiome results in increased microbial colonization of IPPs.

Methods
We performed an ex vivo study focusing on the reservoir and tips of Coloplast Titan IPP. Conditions of an IPP surgery were attempted to be closely replicated. Setup included a dedicated table within the same institutional OR where IPPs are routinely performed, facilitating sample collection, and with standard intra-operative conditions-pressure 0.024”WC, temperature 66.80F, and humidity 49.2% RH-to emulate surgical conditions. Stringent surgical hygiene was observed to obtain samples in a sterile manner; this including surgical scrub, sterile field, and double-glove technique. A sterile swab was collected at 30-minute intervals over a total duration of 3 hours, from each individual component of the IPP, resulting in a total of 6 samples per component. To prevent any potential interference from previous samples, care was taken to collect each swab from distinct areas. The obtained swabs were subjected to quantitative polymerase chain reaction (qPCR) and next generation sequencing (NGS) analyses of the V12 16S rRNA conservative region using the MiSeq platform (Illumina, San Diego, CA) with 2x250 paired read chemistry. Subsequent bioinformatic processing was carried out utilizing a clustering-based method with operational taxonomic units set at a 97% similarity threshold, and taxonomic assignment was accomplished using an internally maintained taxonomic classifier.

Results
The results of the study, obtained through both standard culture and next-generation sequencing (NGS) analyses, demonstrated consistent and significant findings. Through rigorous examination, it was determined that no microbial growth was detected on any component of the inflatable penile prostheses (IPPs) throughout the entire duration of the experiment, which lasted up to 3 hours. This dual approach of standard culture and NGS provided comprehensive and robust evidence of the absence of microbial colonization on the IPP devices.

Conclusions
These findings suggest that the duration of exposure to the OR aerobiome alone does not appear to increase the risk of microbial colonization on IPP devices. Further ex vivo studies are needed to support these findings and evaluate whether factors such as time of skin-to-IPP contact or changes in OR conditions contribute to risk of IPP microbial colonization.

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