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Title: | AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis | 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, Jr. Simhan, Jay VAN RENTERGHEM, Koenraad Warner, J. Nicholas Ziegelmann, Matthew Yafi, Faysal A. |
Issue Date: | 2023 | Publisher: | LIPPINCOTT WILLIAMS & WILKINS | Source: | JOURNAL OF UROLOGY, 209 (2) , p. 399 -406 | 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. | Notes: | Barham, DW (corresponding author), Univ Calif Irvine, Dept Urol, 333 City Blvd West,Suite 1240, Orange, CA 92868 USA. dbarham@hs.uci |
Keywords: | erectile dysfunction;penile prosthesis;infections | Document URI: | http://hdl.handle.net/1942/41717 | DOI: | 10.1097/JU.0000000000003071 | ISI #: | 000928267800023 | Rights: | 2022 by American Urological Association Education and Research, Inc. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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