Molecular testing with next-generation sequencing appears to identify biofilm on penile prostheses better than traditional cultures: The new gold standard?

INTRODUCTION: Traditional culture is the current standard-of-care to determine therapeutic antibiotics for patients suffering from penile prostheses (PP) infections. However, approximately 50% of PPs removed for infection are culture negative. Next-generation sequencing (NGS) compares DNA sequences to reference sequences with known microbial taxonomies to identify isolates and report relative abundances. We aim to compare the ability for standard culture and NGS techniques to identify microorganisms and biofilm composition on PPs. MATERIALS AND METHODS: Ninety-one PPs explanted for mechanical malfunction were included in this study. Devices removed for infection or erosion were excluded. During revision surgery, two specimens were collected and sent for culture testing at institutional laboratory and for NGS testing (MicroGenDx, Lubbock, TX, USA). Species' relative abundances, sample diversity and richness, and compositional differences among samples were analyzed. RESULTS: NGS had a higher rate of microbial detection (n = 72, 79.1%) compared to culture results (n = 3, 3.3%). Some of the bacteria identified using both methods were known prosthetic infectious pathogens, with NGS producing more isolates (mean: 11) than culture (mean: 1). Escherichia coli was the most abundant and most frequently occurring bacteria detected on NGS. Coagulase-negative Staphylococci were the most common bacteria detected on traditional culture. CONCLUSIONS: NGS appears to be beneficial in its thorough analysis of PP biofilm composition when compared to culture methods. We hope that further research will be able to demonstrate a clinical benefit of NGS in characterizing distinct microbiomes and biofilms of infected PP, which can aid in tailoring antimicrobial therapy and improving patient outcomes.

Síndrome de teratoma creciente: reporte de caso y revisión de la literatura / Growing ovarian teratoma syndrome: Case report and literature review / Growing ovarian teratoma syndrome: Case report and literature review

RESUMEN El síndrome de teratoma creciente (STC) es una condición infrecuente en la que se evidencia aumento de tamaño de los tumores de células germinales o la aparición de nuevas lesiones, durante o después del tratamiento con quimioterapia. Lo más característico de este tumor es la presencia exclusiva de componentes de teratoma maduro, así como valores de marcadores tumorales que negativizan durante la quimioterapia, y se mantienen negativos durante el seguimiento. Se presenta el caso de una mujer de 28 años con un tumor de ovario de células germinales mixtas sometida a cirugía y luego quimioterapia. Durante el seguimiento, desarrolló múltiples tumores pélvicos que correspondieron a teratomas maduros. En esta paciente, fue crucial identificar el síndrome de teratoma creciente para evitar tratamiento adicional con quimioterapia.

ABSTRACT The growing teratoma syndrome (GTS) is a rare condition in which patients with germ cell tumors present an increase in tumor size or the appearance of new lesions, during or after chemotherapy. The hallmark of this tumor is the unique presence of mature teratoma components, as well as tumor marker values that become negative with chemotherapy, and remain low thereafter. We report the case of a 28-yearold female who presented a mixed germ cell tumor of the ovary, for which she underwent surgery and subsequent chemotherapy. Later, she developed multiple pelvic tumors that corresponded to mature teratoma. It was crucial in this patient to identify the syndrome to avoid additional treatment with chemotherapy.