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Review
. 2024 May 31;13(5):833-845.
doi: 10.21037/tau-23-550. Epub 2024 May 7.

Emerging strategies for the prevention of bacterial biofilm in prosthetic surgery

Michael K Tram  1 , Joshua Schammel  1 , Rachel Vancavage  1 , Charles Welliver  1   2 , Brian M Inouye  1
Affiliations
Review

Emerging strategies for the prevention of bacterial biofilm in prosthetic surgery

Michael K Tram et al. Transl Androl Urol. .

Abstract

Penile prosthesis implantation is an effective treatment for erectile dysfunction (ED) with high patient satisfaction and effectiveness. Unfortunately, infections remain a dreaded complication, often necessitating device removal and imposing a substantial healthcare cost. Biofilms are communities of microorganisms encased in a self-produced polymeric matrix that can attach to penile prostheses. Biofilms have been demonstrated on the majority of explanted prostheses for both infectious and non-infectious revisions and are prevalent even in asymptomatic patients. Biofilms play a role in microbial persistence and exhibit unique antibiotic resistance strategies that can lead to increased infection rates in revision surgery. Biofilms demonstrate physical barriers through the development of an extracellular polymeric substance (EPS) that hinders antibiotic penetrance and the bacteria within biofilms demonstrate reduced metabolic activity that weakens the efficacy of traditional antibiotics. Despite these challenges, new methods are being developed and investigated to prevent and treat biofilms. These treatments include surface modifications, biosurfactants, tissue plasminogen activator (tPA), and nitric oxide (NO) to prevent bacterial adhesion and biofilm formation. Additionally, novel antibiotic treatments are currently under investigation and include antimicrobial peptides (AMPs), bacteriophages, and refillable antibiotic coatings. This article reviews biofilm formation, the challenges that biofilms present to conventional antibiotics, current treatments, and experimental approaches for biofilm prevention and treatment.

Keywords: Biofilm; infection; penile prosthesis; treatment.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-23-550/coif). The series “Genitourinary Prosthesis Infection” was commissioned by the editorial office without any funding or sponsorship. C.W. has been compensated for CME content creation for Oakstone Publishing and Medscape. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Prevalence of erectile dysfunction and rates of penile prosthesis infections. ED, erectile dysfunction.
Figure 2
Figure 2
Steps of biofilm development. ① Bacterial attachment utilizing van der Waals forces (A) and bacterial proteins (B); ② bacterial aggregation and accumulation through the development of structural layers via intercellular adhesions; ③ biofilm maturation and EPS development which protects the colony and allows for nutrient transport; ④ biofilm detachment due to quorum sensing and induction of cleavage enzymes or mechanical disruption allows for biofilm remnants to enter the blood stream or seed new locations or prosthetics. EPS, extracellular polymeric substance.
Figure 3
Figure 3
Disruption of the existing biofilm during revision surgery leading to infection of the new implant.
See this image and copyright information in PMC

References

    1. Rojanasarot S, Williams AO, Edwards N, et al. Quantifying the number of US men with erectile dysfunction who are potential candidates for penile prosthesis implantation. Sex Med 2023;11:qfad010. 10.1093/sexmed/qfad010 - DOI - PMC - PubMed
    1. Baas W, O'Connor B, Welliver C, et al. Worldwide trends in penile implantation surgery: data from over 63,000 implants. Transl Androl Urol 2020;9:31-7. 10.21037/tau.2019.09.26 - DOI - PMC - PubMed
    1. Serefoglu EC, Mandava SH, Gokce A, et al. Long-term revision rate due to infection in hydrophilic-coated inflatable penile prostheses: 11-year follow-up. J Sex Med 2012;9:2182-6. 10.1111/j.1743-6109.2012.02830.x - DOI - PubMed
    1. Carson CC, 3rd, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of followup. J Urol 2011;185:614-8. 10.1016/j.juro.2010.09.094 - DOI - PubMed
    1. Bernal RM, Henry GD. Contemporary patient satisfaction rates for three-piece inflatable penile prostheses. Adv Urol 2012;2012:707321. 10.1155/2012/707321 - DOI - PMC - PubMed