1371 HIGH BACTERIAL COLONIZATION RATE OF INTERSTIM CONNECTORS AND CLINICAL INFECTION WITH STAGED INTERSTIM TESTING

Shaun Grewal; H. Henry Lai

doi:10.1016/j.juro.2013.02.2725

INTRODUCTION AND OBJECTIVES To investigate the bacterial colonization rate of Interstim connectors and the clinical infection rate of staged Interstim testing. METHODS 36 consecutive patients who were scheduled to have staged Interstim surgery were enrolled into this prospective study. During the second stage Interstim surgery (which occurred 14 to 21 days after the first stage procedure), immediately after the connector site incision was opened, aerobic and anaerobic cultures were obtained by swabbing the connector pocket and the Interstim connector itself with dry, sterile, cotton tipped swabs. The swabs were then sent for aerobic and anaerobic cultures, to examine the rate of bacterial colonization at the connector sites. Subsequent clinical infection rate and outcome were also noted. RESULTS During the second stage procedure, 27% of patients (n=9) showed positive bacterial cultures when the connectors and connector pockets were swabbed. Coagulase negative staphylococcus and methicillin resistant staph aureus (MRSA) were the most common organisms. 4 out of 9 patients (45%) who had positive cultures at the connectors developed clinical infection of the Interstim. In contrast, only 1 out of 19 patients (5%) who had negative cultures at the connectors developed clinical infection (p=0.02, Fisher's exact test, 2-tailed). The difference was statistically significant. Among the 4 patients who had a colonized connector and developed clinical infection, two ultimately required Interstim explant from the infection, while the other two were successfully managed with oral antibiotics. Although patients who had positive cultures did not differ from patients who had negative cultures in terms of age, gender, surgery time, diabetes status and smoking status, a trend was noted between the number of days between the first and second stage procedures. The rate of colonization was 17% (4 of 24) in patients who had ≤14 days of testing compared to 50% (5 of 10) in patients who had 21 days of testing (p=0.084, 2-sided t-test). CONCLUSIONS The risk of Interstim colonization is significant using the staged, tined lead testing approach, since a foreign body is present and is externalized, providing a portal for bacterial entry from the connector wire. While the infection rate is still acceptable, innovative strategies must be implemented to further reduce the risks of bacterial colonization and biofilm formation of the device.

1371 HIGH BACTERIAL COLONIZATION RATE OF INTERSTIM CONNECTORS AND CLINICAL INFECTION WITH STAGED INTERSTIM TESTING

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