TY - JOUR
T1 - A Multicenter Investigation Examining American Urological Association Recommended Antibiotic Prophylaxis vs Nonstandard Prophylaxis in Preventing Device Infections in Penile Prosthesis Surgery in Diabetic Patients
AU - Rezaee, Michael E.
AU - Towe, Maxwell
AU - Osman, Mohamad M.
AU - Huynh, Linda M.
AU - El-Khatib, Farouk M.
AU - Andrianne, Robert
AU - Broderick, Gregory
AU - Burnett, Arthur L.
AU - Gross, Martin S.
AU - Guise, Amy I.
AU - Hatzichristodoulou, Georgios
AU - Henry, Gerard D.
AU - Clavell-Hernandez, Jonathan
AU - Hsieh, Tung Chin
AU - Jenkins, Lawrence C.
AU - Lentz, Aaron
AU - Munarriz, Ricardo M.
AU - Osmonov, Daniar
AU - Park, Sung Hun
AU - Perito, Paul
AU - Sadeghi-Nejad, Hossein
AU - Sempels, Maxime
AU - Simhan, Jay
AU - Wang, Run
AU - Yafi, Faysal A.
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Purpose:American Urological Association (AUA) antibiotic prophylaxis recommendations may be insufficient for covering organisms commonly found in penile prosthesis infections. In this study we assess the difference between AUA recommended antibiotic prophylaxis and nonstandard prophylaxis in preventing device infections in penile prosthesis surgery performed in diabetic patients.Materials and Methods:A multicenter, retrospective cohort study of diabetic patients undergoing primary penile prosthesis surgery was performed between April 2003 and August 2018. Eighteen institutions from the United States, Europe and Korea contributed. The association between antibiotic prophylaxis type and postoperative penile prosthesis infections, device explantations and revision surgeries was assessed.Results:Standard AUA antibiotic prophylaxis was followed in 48.6% (391) of cases while nonstandard prophylaxis was used in 51.4% (413). Common nonstandard antibiotic prophylaxis included vancomycin-gentamycin-fluoroquinolone, clindamycin-fluoroquinolone, and vancomycin-fluoroquinolone among other combinations. Patients who received AUA prophylaxis had significantly more postoperative device infections (5.6% vs 1.9%, p <0.01) and explantations (8.3% vs 2.0%, p <0.001) compared to those who received nonstandard prophylaxis. Patients who received AUA prophylaxis had significantly higher odds of a postoperative device infection (OR 2.8, 95% CI 1.1-7.3) and explantation (OR 3.6, 95% CI 1.4-9.1) compared to those who received nonstandard prophylaxis.Conclusions:Diabetic men with erectile dysfunction who received standard AUA prophylaxis for penile prosthesis surgery had significantly greater odds of experiencing a postoperative device infection and device explantation compared to patients who received nonstandard prophylaxis. Our study provides a strong rationale for a prospective investigation to establish the most appropriate prophylaxis strategy in penile prosthesis surgery.
AB - Purpose:American Urological Association (AUA) antibiotic prophylaxis recommendations may be insufficient for covering organisms commonly found in penile prosthesis infections. In this study we assess the difference between AUA recommended antibiotic prophylaxis and nonstandard prophylaxis in preventing device infections in penile prosthesis surgery performed in diabetic patients.Materials and Methods:A multicenter, retrospective cohort study of diabetic patients undergoing primary penile prosthesis surgery was performed between April 2003 and August 2018. Eighteen institutions from the United States, Europe and Korea contributed. The association between antibiotic prophylaxis type and postoperative penile prosthesis infections, device explantations and revision surgeries was assessed.Results:Standard AUA antibiotic prophylaxis was followed in 48.6% (391) of cases while nonstandard prophylaxis was used in 51.4% (413). Common nonstandard antibiotic prophylaxis included vancomycin-gentamycin-fluoroquinolone, clindamycin-fluoroquinolone, and vancomycin-fluoroquinolone among other combinations. Patients who received AUA prophylaxis had significantly more postoperative device infections (5.6% vs 1.9%, p <0.01) and explantations (8.3% vs 2.0%, p <0.001) compared to those who received nonstandard prophylaxis. Patients who received AUA prophylaxis had significantly higher odds of a postoperative device infection (OR 2.8, 95% CI 1.1-7.3) and explantation (OR 3.6, 95% CI 1.4-9.1) compared to those who received nonstandard prophylaxis.Conclusions:Diabetic men with erectile dysfunction who received standard AUA prophylaxis for penile prosthesis surgery had significantly greater odds of experiencing a postoperative device infection and device explantation compared to patients who received nonstandard prophylaxis. Our study provides a strong rationale for a prospective investigation to establish the most appropriate prophylaxis strategy in penile prosthesis surgery.
KW - Aged
KW - Anti-Bacterial Agents/therapeutic use
KW - Antibiotic Prophylaxis/methods
KW - Diabetes Mellitus/immunology
KW - Drug Therapy, Combination/methods
KW - Erectile Dysfunction/surgery
KW - Europe/epidemiology
KW - Humans
KW - Male
KW - Middle Aged
KW - Penile Prosthesis/adverse effects
KW - Practice Guidelines as Topic
KW - Prospective Studies
KW - Prosthesis Implantation/adverse effects
KW - Prosthesis-Related Infections/epidemiology
KW - Reoperation/statistics & numerical data
KW - Republic of Korea/epidemiology
KW - Retrospective Studies
KW - Societies, Medical/standards
KW - Treatment Outcome
KW - United States/epidemiology
KW - Urology/standards
UR - http://www.scopus.com/inward/record.url?scp=85089458075&partnerID=8YFLogxK
U2 - 10.1097/JU.0000000000001158
DO - 10.1097/JU.0000000000001158
M3 - Article
C2 - 32519913
AN - SCOPUS:85089458075
SN - 0022-5347
VL - 204
SP - 969
EP - 975
JO - Journal of Urology
JF - Journal of Urology
IS - 5
ER -
