A Multicenter Investigation Examining American Urological Association Recommended Antibiotic Prophylaxis vs Nonstandard Prophylaxis in Preventing Device Infections in Penile Prosthesis Surgery in Diabetic Patients

Rezaee, Michael E.; Towe, Maxwell; Osman, Mohamad M.; Huynh, Linda; El‐Khatib, Farouk M.; Andrianne, Robert; Broderick, Gregory A.; Burnett, Arthur L.; Gross, Martin; Guise, Amy I.; Hatzichristodoulou, Georgios; Henry, Gerard D.; Clavell-Hernández, Jonathan; Hsieh, Tung-Chin; Jenkins, Lawrence C.; Lentz, Aaron; Munárriz, Ricardo; Park, Sung Hun; Perito, Paul; Sadeghi‐Nejad, Hossein; Sempels, Maxime; Simhan, Jay; Wang, Run; Yafi, Faysal A.

doi:10.1097/ju.0000000000001158

Cited by 14 publications

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“…Vancomycin plus gentamicin has become the most commonly used regimen among prosthetic surgeons. 4,9 Therefore, we chose to test the most widely used regimen recommended by the AUA (vancomycin plus gentamicin alone) against all other regimens. Multiple series have demonstrated the risks of fungal infections in diabetics undergoing penile prosthesis placement as well as the important role of antifungals in this high-risk group.…”

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

“…9,10 Nevertheless, recent evidence suggested regimens that have been recommended by the AUA and EAU may be associated with a higher postoperative infection rate than nonstandard regimens. 4,9 Accordingly, the EAU no longer publishes specific guidance on perioperative prophylaxis, leaving surgeons with only the AUA recommendation regarding specific regimens. Recent evidence also suggests the use of antifungal agents, especially in high-risk groups, may provide more robust prophylaxis; 4 however, the role of antifungals in patients undergoing primary IPP surgery remains unclear.…”

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confidence: 99%

“…Previously, our multi-institutional collaborative demonstrated the standard AUA antimicrobial prophylaxis was less effective than an aggregate of comparator regimens in men with diabetes. 4 Here, our aim was to evaluate the AUA antimicrobial prophylaxis in all men undergoing IPP placement. We hypothesized that vancomycin plus gentamicin alone would be associated with a higher risk of infection while the use of antifungals would be associated with lower risk in primary IPP placement.…”

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confidence: 99%

“…1,2 Implant infection is one of the most feared complications, but occurs in only 1%-6% of patients undergoing penile prosthesis surgery with higher rates in diabetics and revision cases. 3,4 Device infection can be associated with the need for further surgery, sexual dysfunction, penile length loss, and medicolegal implications. 5,6 Due to the devastating impacts of inflatable penile prosthesis (IPP) infections, surgeons take many steps to decrease infection, including the use of antibiotic impregnated/coated devices, antiseptic surgical scrub, no-touch technique, wound irrigation, and perioperative antimicrobial prophylaxis.…”

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AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis

et al. 2023

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Purpose: Our aim was to determine if the AUA-recommended prophylaxis (vancomycin D 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 D 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.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis

et al. 2023

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Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery

Sun

Callegari

Zhou

et al. 2023

Neurourology and Urodynamics

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Introduction and Objective Perioperative antimicrobial prophylaxis is crucial for prevention of prosthesis and patient morbidity after artificial urinary sphincter (AUS) placement. While antibiotic guidelines exist for many urologic procedures, adoption patterns for AUS surgery are unclear. We aimed to assess trends in antibiotic prophylaxis for AUS and outcomes relative to American Urological Association (AUA) Best Practice guidelines. Methods The Premier Healthcare Database was queried from 2000 to 2020. Encounters involving AUS insertion, revision/removal, and associated complications were identified via ICD and CPT codes. Premier charge codes were used to identify antibiotics used during the insertion encounter. AUS‐related complication events were found using patient hospital identifiers. Univariable analysis between hospital/patient characteristics and use of guideline‐adherent antibiotics was done via chi‐squared and Kruskal–Wallis tests. A multivariable logistic mixed effects model was used to assess factors related to the odds of complication, specifically the use of guideline‐adherent versus nonadherent regimens. Results Of 9775 patients with primary AUS surgery, 4310 (44.1%) received guideline‐adherent antibiotics. The odds of guideline‐adherent regimen use increased 7.7% per year with 53.0% (830/1565) receiving guideline‐adherent antibiotics by the end of the study period. Patients with guideline‐adherent regimens had a decreased risk of any complication (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.74–0.93) and surgical revision (OR: 0.85, 95% CI: 0.74–0.96) within 3 months; however, no significant difference in infection within was noted (OR: 0.89, 95% CI: 0.68–1.17) within 3 months. Conclusions Adherence to AUA antimicrobial guidelines for AUS surgery appears to have increased over the last two decades. While guideline‐adherent regimens were associated with decreased risk of any complication and surgical intervention, no significant association was found with risk of infection. Surgeons appear to be increasingly following AUA recommendations for antimicrobial prophylaxis for AUS surgery, however, further level 1 evidence should be obtained to demonstrate conclusive benefit of these regimens.

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Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients with Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis

Towe

Huynh

Osman

et al. 2020

The Journal of Sexual Medicine

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Background Modern-day penile prostheses use infection retardant coating to decrease rates of postoperative infection, subsequently reducing explantation and revision rates as well. The Coloplast Titan models are dipped into antimicrobial solutions right before implantation, and the components used for dipping can be tailored toward the patient. Aim To compare infection, explantation, and revision rates among different dipping solutions used before implantation for patients with diabetes receiving a Coloplast Titan implant. Methods We systematically reviewed 932 patients with diabetes receiving a primary penile implant across 18 different centers from the period April 2003 to August 2018. Of those patients, 473 received a Coloplast device, whereas 459 received an AMS device. Data regarding the type of antimicrobial solution used before implantation were recorded for 468 patients receiving a Coloplast Titan, including whether or not they suffered a postoperative infection and if they underwent explantation and/or revision. Outcome rates were compared using Fisher’s exact and Pearson’s chi-square tests, and logistic regression modeling was performed to account for covariates. Outcomes The main outcome measures of this study were postoperative infection, explantation, and revision rates. Results Of the total 932 patients reviewed, 33 suffered a postoperative infection. Of 468 patients receiving Coloplast implants, there was a 3.4% infection rate. The most commonly used antibiotic combination before dipping was vancomycin + gentamicin (59.0%). There was a significantly lower rate of postoperative infection, explantation, and revision when vancomycin + gentamicin was used than those associated with the use of all other dipping solutions ([1.4% vs 6.4%; P = .004], [1.1% vs 8.3%; P < .001], and [2.5% vs 12.5; P < .001], respectively). After adjusting for age, body mass index, preoperative blood glucose level, and hemoglobin A1c, the use of other dips was an independent predictor of postoperative infection (odds ratio: 0.191; P = .049). The inclusion of rifampin in the dipping solution trended toward being a significant risk factor for infection (P = .057). Including antifungals in the dipping solution did not affect infection (P = .414), explantation (P = .421), or revision (P = .328) rates. Clinical Implications Vancomycin + gentamicin was the most efficacious combination of antibiotics used for dipping in terms of preventing postoperative infection and subsequent explantation and revision. Strengths and Limitations Data were sampled across multiple institutions providing a large sample that may be more representative of the population of interest. A key limitation of the study was its retrospective nature, which prevented us from controlling certain variables. Conclusion The use of rifampin did not provide the same type of protection, possibly representing a shift in resistance patterns of common bacteria responsible for device infection.

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A Multicenter Investigation Examining American Urological Association Recommended Antibiotic Prophylaxis vs Nonstandard Prophylaxis in Preventing Device Infections in Penile Prosthesis Surgery in Diabetic Patients

Cited by 14 publications

References 0 publications

AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis

AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis

Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery

Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients with Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis

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