Biofilms of inflatable penile prosthetics

AimTo characterize microbial biofilms of indwelling penile prosthesis devices by component, manufacturer, and infection status.MethodsUpon explantation or revision of penile prostheses, device biofilms were extracted and characterized using a combination of amplicon sequencing, meta-culturomics, shotgun metagenomics, and culture-based approaches. Device components were also analyzed using scanning electron microscopy.ResultsAll analyzed device components from twenty devices had detectable microbial biofilms, even in the absence of infection. There was a greater number of observed viral species present in devices by manufacturer B than manufacturer A. Biofilms were otherwise similar regardless of device manufacturer, device component, and device infection status.Clinical ImplicationsEradication or complete prevention of biofilm may not be the optimal strategy for infection prevention or treatment. Rather, prevention of the transition to the dysbiotic state may prevent infection while maintaining good antibiotic stewardship practice. Specifically targeting this transition is an area for future work.Strengths and LimitationsThis study comprehensively characterized biofilm composition on penile prosthesis devices. Its strengths include the multi-pronged approach wherein next-generation sequencing, shotgun metagenomics, and scanning electron microscopy were used in tandem to characterize biofilms from multiple components of the devices. Limitations include few infected devices, and a relatively small subset of devices that were included in shotgun metagenomics analysis.ConclusionPenile prosthesis biofilms are present even in the absence of infection, and are broadly similar by device manufacturer, device component, and infection status.