1887

Abstract

Penile implant infections are a possible surgical complication that has historically been most commonly associated with Gram-positive bacteria. is a Gram-positive bacteria and is the most common cause of endocarditis.

A male patient in his 50s with a past medical history of hypertension, diabetes, end-stage renal disease (ESRD) on peritoneal dialysis (PD) and erectile dysfunction with a penile implant placed 6 years prior to the admission date presented with complaints of scrotal pain. The pump for his implant had eroded through his scrotum and was draining pus. Blood cultures returned positive for Gram-positive cocci in clusters in 4/4 bottles, which was eventually identified as methicillin-sensitive (MSSA). A transthoracic echocardiogram (TTE) was performed due to concern for infective endocarditis (IE) but did not show any valvular abnormalities. Due to high clinical suspicion, a transesophageal echocardiogram (TEE) was performed and revealed a vegetation on the native mitral valve. His penile implant was removed by urology and intraoperative cultures grew MSSA. Surgical valve replacement was not recommended, and the patient was sent home with IV antibiotics for 6 weeks.

Post-operative site infections are a quite uncommon point of entry for infective endocarditis, with penile implant infections being an even rarer cause. While a TTE is often used initially to attempt to diagnose infective endocarditis, it has lower sensitivity than a TEE. If clinical suspicion for infective endocarditis remains high after negative imaging with TTE, then TEE should be performed for better visualization of the heart valves.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. The Microbiology Society waived the open access fees for this article.
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/content/journal/acmi/10.1099/acmi.0.000295
2021-12-09
2022-01-28
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References

  1. Gross MS, Phillips EA, Carrasquillo RJ, Thornton A, Greenfield JM et al. Multicenter investigation of the micro-organisms involved in penile prosthesis infection: an analysis of the efficacy of the AUA and EAU guidelines for penile prosthesis prophylaxis. J Sex Med 2017; 14:455–463 [View Article] [PubMed]
    [Google Scholar]
  2. Dawn LE, Henry GD, Tan GK, Wilson SK. Biofilm and infectious agents present at the time of penile prosthesis revision surgery: times are a changing. Sex Med Rev 2017; 5:236–243 [View Article] [PubMed]
    [Google Scholar]
  3. Cahill TJ, Prendergast BD. Infective endocarditis. Lancet 2016; 387:882–893 [View Article] [PubMed]
    [Google Scholar]
  4. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta J-P et al. 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J 2015; 36:3075–3128 [View Article]
    [Google Scholar]
  5. Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol 2015; 65:2070–2076 [View Article] [PubMed]
    [Google Scholar]
  6. Lotan Y, Roehrborn CG, McConnell JD, Hendin BN. Factors influencing the outcomes of penile prosthesis surgery at a teaching institution. Urology 2003; 62:918–921 [View Article] [PubMed]
    [Google Scholar]
  7. Delahaye F, M’Hammedi A, Guerpillon B, de Gevigney G, Boibieux A et al. Systematic search for present and potential portals of entry for infective endocarditis. J Am Coll Cardiol 2016; 67:151–158 [View Article] [PubMed]
    [Google Scholar]
  8. Wang A, Gaca JG, Chu VH. Management considerations in infective endocarditis: a review considerations in infective endocarditis: a review. JAMA 2018; 320:72–83 [View Article] [PubMed]
    [Google Scholar]
  9. Shively BK, Gurule FT, Roldan CA, Leggett JH, Schiller NB. Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. J Am Coll Cardiol 1991; 18:391–397 [View Article] [PubMed]
    [Google Scholar]
  10. Chang F-Y, MacDonald BB, Peacock JE, Musher DM, Triplett P et al. A prospective multicenter study of Staphylococcus aureus bacteremia: incidence of endocarditis, risk factors for mortality, and clinical impact of methicillin resistance. Medicine (Baltimore) 2003; 82:322–332 [View Article] [PubMed]
    [Google Scholar]
  11. Palraj BR, Baddour LM, Hess EP, Steckelberg JM, Wilson WR et al. Predicting risk of endocarditis using a clinical tool (PREDICT): scoring system to guide use of echocardiography in the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2015; 61:18–28 [View Article] [PubMed]
    [Google Scholar]
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