TY - JOUR
T1 - AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection
T2 - A Multicenter Analysis
AU - on behalf of the PUMP (Prosthetic Urology Multi-institutional Partnership) Collaborators
AU - Barham, David W.
AU - Pyrgidis, Nikolaos
AU - Gross, Martin S.
AU - Hammad, Muhammed
AU - Swerdloff, Daniel
AU - Miller, Jake
AU - Alkhayal, Abdullah
AU - Alrabeeah, Khalid A.
AU - Andrianne, Robert
AU - Burnett, Arthur L.
AU - Gross, Kelli
AU - Hatzichristodoulou, Georgios
AU - Hotaling, James M.
AU - Hsieh, Tung Chin
AU - Jones, Adam
AU - Jones, James M.
AU - Lentz, Aaron
AU - Levy, Jason
AU - Modgil, Vaibhav
AU - Osmonov, Daniar
AU - Park, Sung Hun
AU - Pearce, Ian
AU - Perito, Paul
AU - Sadeghi-Nejad, Hossein
AU - Sempels, Maxime
AU - Suarez-Sarmiento, Alfredo
AU - Simhan, Jay
AU - Van Renterghem, Koenraad
AU - Warner, J. Nicholas
AU - Ziegelmann, Matthew
AU - Yafi, Faysal A.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - 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.
AB - 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.
KW - erectile dysfunction
KW - infections
KW - penile prosthesis
UR - http://www.scopus.com/inward/record.url?scp=85145954849&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85145954849&partnerID=8YFLogxK
U2 - 10.1097/JU.0000000000003071
DO - 10.1097/JU.0000000000003071
M3 - Article
C2 - 36383789
AN - SCOPUS:85145954849
SN - 0022-5347
VL - 209
SP - 399
EP - 409
JO - Journal of Urology
JF - Journal of Urology
IS - 2
ER -