AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis.
J Urol
; 209(2): 399-409, 2023 02.
Article
in En
| MEDLINE
| ID: mdl-36383789
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 ANDMETHODS:
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Penile Prosthesis
/
Penile Implantation
/
Erectile Dysfunction
Type of study:
Clinical_trials
/
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
/
Male
Language:
En
Journal:
J Urol
Year:
2023
Document type:
Article