Perioperative Antimicrobial Strategies in Inflatable Penile Prosthesis Surgery: Associations Between Antifungals, Oral Antibiotics, and Intravenous Antibiotic Duration, and Infection Outcomes

Abstract

Purpose: This study aims to evaluate the association between antimicrobial practices, including oral antibiotics, IV antibiotics, and antifungal prophylaxis, and infection outcomes in patients undergoing primary or revision inflatable penile prosthesis surgery. Materials and Methods: We conducted a multicenter, retrospective cohort study of 5261 patients who underwent primary or revision inflatable penile prosthesis surgery at 16 specialized centers across the United States, Europe, and Korea from July 2016 to July 2021. Patient data included demographic and clinical characteristics, antibiotic and antifungal administration, and infection outcomes. The primary outcome was infection after inflatable penile prosthesis placement. Univariable and multi-variable regression analyses were performed to identify predictors of infection. Results: The overall infection rate was 1.9% (n = 102), with higher rates among diabetic patients (P = .023), those with prior inflatable penile prosthesis infection (P < .001), or undergoing revision surgery (P < .001). Multivariable analysis identified diabetes (odds ratio [OR] = 1.68, P = .022) and previous inflatable penile prosthesis infection (OR = 4.67, P < .001) as independent risk factors for infection. Perioperative IV antifungal use was significantly associated with a lower infection risk (OR = 0.22, P < .001), whereas postoperative oral antibiotics (P = .5) and prolonged IV antibiotic prophylaxis (>24 hours; P = .2) did not demonstrate protective effects. Preoperative and postoperative oral antibiotics were not associated with a statistically significant reduction in infection after adjustment for confounding variables. Conclusions: This large multicenter study highlights a significant association between perioperative antifungal prophylaxis and lower infection risk in inflatable penile prosthesis surgery while demonstrating the limited utility of preoperative and postoperative oral antibiotics and prolonged IV prophylaxis. These findings support evidence-based antimicrobial stewardship to optimize outcomes and minimize complications, including antibiotic resistance.