Multicenter Investigation on the Influence of Climate in Penile Prosthesis Infection
Martin S. Gross, MD1; Jason M. Greenfield, MD2; Laurence A. Levine, MD3; Joseph Alukal, MD4; William P. Conners, III, MD5; Cigdem Tanrikut, MD6; Stanton C. Honig, MD7; Nelson E. Bennett, Jr., MD8; Run Wang, MD9; Paul E. Perito, MD10; Peter J. Stahl, MD11; Mariano Rosselló Gayá, MD12; Mariano Rosselló Barbará, MD12; Edward Gheiler, MD13; David J. Ralph, MD14; Doron S. Stember, MD15; Rafael E. Carrion, MD16; Tobias S. Kohler, MD17; Pedro P. Maria, DO18; William O. Brant, MD19; Bruce B. Garber, MD20; Arthur L. Burnett, MD21; J. Francois Eid, MD22; Gerard D. Henry, MD23; Ricardo M. Munarriz, MD24
1Dartmouth-Hitchcock Medical Center/Dartmouth-Hitchcock Keene, Keene, NH; 2Urology Associates of North Texas, Arlington, TX; 3Rush Medical College, Chicago, IL; 4New York University School of Medicine, New York City, NY; 5Beth Israel Deaconess Medical Center, Boston, MA; 6University of Maryland School of Medicine, Baltimore, MD; 7Yale University School of Medicine, New Haven, CT; 8Northwestern University Feinberg School of Medicine, Chicago, IL; 9McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; 10Perito Urology, Coral Gables, FL; 11Columbia University College of Physicians and Surgeons, New York City, NY; 12Instituto Medico Rosselló, Madrid, Spain, 13Urology Specialists, Hialeah, FL; 14University College London, London, United Kingdom, 15Mount Sinai Hospital, New York City, NY; 16University of South Florida Morsani College of Medicine, Tampa, FL; 17Mayo Clinic, Rochester, MN; 18Albert Einstein College of Medicine, New York City, NY; 19Intermountain Medical Center, Salt Lake City, UT; 20Hahnemann University Hospital, Philadelphia, PA; 21The Johns Hopkins University School of Medicine, Baltimore, MD; 22Advanced Urological Care, New York City, NY; 23Ark-La-Tex Urology, Shreveport, LA; 24Boston University School of Medicine, Boston, MA
BACKGROUND: Studies in other fields have documented a relationship between temperature and surgical site infection. We reviewed our multi-institution database of inflatable penile prosthesis infections to examine the relationship between inflatable penile prosthesis (IPP) infection,culture positivity, time of year, climate, temperature, humidity, and organisms responsible for infection.
METHODS: This is a retrospective IRB-approved analysis of 213 patients at 25 institutions who underwent salvage procedure or device explant between 2001 and 2016. Patient data were compiled after extensive review of operative reports, nursing operative data, intraoperative wound cultures, perioperative antibiotics, inpatient notes, consult notes, and follow-up visits. Climate data were compiled from monthly norms based on location, as well as specific data regarding temperature, dew point, and humidity from dates of surgery. Rigorous statistical analysis was performed.
RESULTS: Infected implants performed in the summer or fall were 2.7 times more likely to grow Gram-positive bacteria compared to implants performed in spring (p=0.005). 139 infections occurred at average daily temperatures greater than 55 degrees F, compared to 72 infections at less than 55 degrees F. The incidence rate ratio for this trend was 1.93, with a p-value of <0.001. 40% more implants would have to be performed at temperatures less than or equal to 55 degrees F than were performed at greater than 55 degrees F for this difference not to be significant. Infections were more likely to occur in devices placed in spring months (61), although the small sample size and lack of a denominator precluded statistical significance. This was consistent across geographic location, including in the Southern hemisphere. Assuming that a similar number of implants are performed in every quarter, the incidence rate ratio for this trend is 1.49, with a p-value of 0.05. Infections occurred most frequently in IPPs placed in June (24). Fewer infections occurred in IPPs placed in winter months (39), with the lowest number occurring in March (11). There were 58 infections in summer months and 55 in fall months.
CONCLUSIONS: To our knowledge these data represent the first exploration of the relationship between temperature and infection in prosthetic urology. Gram-positive infections are nearly 3 times as likely in the summer or fall. Temperature correlates with rates of IPP infection. Infections occur less often in winter months and more often in spring months in our series. Further investigation is needed to confirm our results.
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