AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis. Issue 2 (16th November 2022)

• Record Type: Journal Article
• Authors: Barham, David W.; Pyrgidis, Nikolaos; Gross, Martin S.; Hammad, Muhammed; Swerdloff, Daniel; Miller, Jake; Alkhayal, Abdullah; Alrabeeah, Khalid A.; Andrianne, Robert; Burnett, Arthur L.; Gross, Kelli; Hatzichristodoulou, Georgios; Hotaling, James M.; Hsieh, Tung-Chin; Jones, Adam; Jones, James M.; Lentz, Aaron; Levy, Jason; Modgil, Vaibhav; Osmonov, Daniar; Park, Sung Hun; Pearce, Ian; Perito, Paul; Sadeghi-Nejad, Hossein; Sempels, Maxime; Suarez-Sarmiento, Alfredo; Simhan, Jay; van Renterghem, Koenraad; Warner, J. Nicholas; Ziegelmann, Matthew; Yafi, Faysal A.;
• Is Part Of: Journal of urology. Volume 209:Issue 2(2023)
• Page Start: 399
• Page End: 409
• Publication Date: 2022-11-16
• Subjects: erectile dysfunction, -- penile prosthesis, -- infections; Genitourinary organs -- Periodicals; Urology -- Periodicals; Urology -- Periodicals; Urologie -- Périodiques; Urologie; 616.6
• DOI: 10.1097/JU.0000000000003071
• Languages: English
• ISSNs: 0022-5347

Abstract

Abstract : Purpose: Our aim was to determine if the AUA-recommended prophylaxis (vancomycin + gentamicin alone) for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard regimens. Materials and Methods: We performed a multicenter, retrospective study of patients undergoing primary inflatable penile prosthesis surgery. Patients were divided into those receiving vancomycin + gentamicin alone and those receiving any other regimen. A Cox proportional-hazards model was constructed adjusted for major predictors. A subgroup analysis to identify the appropriate dosage of gentamicin was also performed. Results: A total of 4, 161 patients underwent primary inflatable penile prosthesis placement (2, 411 received vancomycin + gentamicin alone and 1, 750 received other regimens). The infection rate was similar between groups, 1% vs 1.2% for standard vs nonstandard prophylaxis. In the multivariable analysis, vancomycin + gentamicin (HR: 2.7, 95% CI: 1.4 to 5.4, P = .004) and diabetes (HR: 1.9, 95% CI: 1.03 to 3.4, P = .04) were significantly associated with a higher risk of infection. Antifungals (HR: 0.08, 95% CI: 0.03 to 0.19, P < .001) were associated with lower risk of infection. There was no statistically significant difference in infection rate between weight-based gentamicin compared to 80 mg gentamicin (HR: 2.9, 95% CI: 0.83 to 10, P = .1). Conclusions: Vancomycin + gentamicin alone for antibiotic prophylaxis for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard antibiotic regimens while antifungal use is associated with lower infection risk. A critical review of the recommended antimicrobial prophylactic regimens is needed. Prospective research is needed to further elucidate best practices in inflatable penile prosthesis antimicrobial prophylaxis.