Biofilms and Infection

[ElbowRoom]

Hey all...I was using Grok to do research for my surgery, and ended up down the infection/biofilm rabbit hole. Please excuse me if everybody knows all this, but it was new to me so I thought I'd share.

Apparently the big problem with any medical device, including penile implants (I specifically asked about IPPs, but I assume a lot of this applies to MPs as well) is not bacterial contamination itself. That can be resolved with antibiotics. The problem is biofilms, where the bacteria involved form a extracellular polymeric substance (EPS) capsule between the patient's tissue and the implant.

This capsule keeps the bacteria between the EPS layer and the implant itself, effectively shielding the bacteria from both the patient's immune system and any antibiotics. This is the reason implants are coated with antibiotics, to both kill bacteria and to get *under* any biofilms that form.

The Impregnated AMS material keeps antibiotics in contact with anything attempting to initially attach to the implant. Titan takes a different approach, using aqueous antibiotic solutions to prevent perioperative infection, and the hydrophilic coating then provides lasting protection by not allowing bacteria to "stick" to the implant.

The problem is once a biofilm is formed it's like a silent time bomb, and only causes a symptomatic infection when the film is disturbed, exposing the patient's tissues to the underlying bacteria. But then the underlying bacteria can continue leeching out, so antibiotic therapy is ineffective as the patient is continuously reinfected. That's why any significant infection generally results in a complete removal/revision.

These infections can occur anytime, but are most likely within 12 months of surgery when risk of bacterial contamination is highest. HOWEVER, 20-30% of serious infections occur years later, as any bacteria the implant is exposed to can attach and begin forming a biofilm.

Understanding all this, I asked Grok some speculative questions.

First, I asked if rough sex could disrupt an existing biofilm and cause a symptomatic infection. The answer is yes, especially if buckling of the cylinders or flexing of tubing occurs in locations where films have already formed. Just something scary to be aware of.

Secondly, I wondered if ultrasound could break up biofilms and then treat the underlying bacteria with standard antibiotic therapy. The answer was also yes! Apparently this is a technique used with other implant types, but hasn't been well studied yet in IPPs/MPs. It would require careful choice of the ultrasound frequency and energy to avoid weakening components or damaging patient tissues, but there's no reason it couldn't be effective.

I think that's something that should be aggressively studied...using ultrasound + antibiotics could save a lot of patients from revision surgeries when they have otherwise well-functioning implants. It might even be prudent to give a patient a course of antibiotics every three years or so, and a couple of days into the treatment do a complete ultrasonic "cleaning" of the implant components so that the antibiotics can sweep up any contamination.

Grok also mentioned that there are nano-coatings in development to solve the biofilm problem, but it was unclear to me if those are more for "hard" implants like knee replacements, and if they are suited to the softer materials that IPPs use.

Anyway...just the results of my research, which gave me a lot more detail that I knew previously. Carry on!

[Kodixx]

That was a good read -- thanks for posting.

- Chuck

[ElbowRoom]

That was a good read -- thanks for posting.

- Chuck

Glad you enjoyed it!

[wilsonmill]

Excellent write up, I learned something new.

[sambalamba]

Hey all...I was using Grok to do research for my surgery, and ended up down the infection/biofilm rabbit hole. Please excuse me if everybody knows all this, but it was new to me so I thought I'd share.

I do seem to recall from my research which I did sometime ago on this topic that a large population study of explanted implants showed all implants having bacteria on their surface but not necessarily biofilm. I seem to recall a certain critical threshold of bacteria population will trigger the formation of biofilm as a protective barrier for the entire colony. Also read that at the hands of dedicated high volume surgeons with quick surgery times and better infection prevention protocols the chance of colony formation is less.

What did your research say on these matters?

[1day2Bbionic]

Glad you took the time to study and then post your information. That was well worth the read. thanks

[LastHope]

Fascinating read, thank you ElbowRoom for sharing this! I'll upload some slides from a recent SMSNA presentation about biofilms.

[LastHope]

Two more...

[sambalamba]

Two more...

Can you share the SMSNA link. I have an SMSNA account.

[LastHope]

Two more...

Can you share the SMSNA link. I have an SMSNA account.

They had it embedded in the Education>Videos section, but now it's open access in YouTube.

https://youtu.be/UK-HX-8loNc?si=bWEPw0lpYCJ8kLCC