Intraoperative 0.05% Chlorhexidine Gluconate Utilization Is Associated with an Increased Incidence of Infection in Hydrophilic Inflatable Penile Prosthesis Surgery: a Multi-institutional Cohort Study

PURPOSE: Available data are conflicting and limited regarding the antimicrobial effectiveness of 0.05% chlorhexidine gluconate (0.05% CHG) with hydrophilic inflatable penile prostheses (IPP). We used a large multi-institutional cohort to explore the relationship between intraoperative 0.05% CHG use and hydrophilic IPP infection.

MATERIALS AND METHODS: We conducted a retrospective, multi-institutional review of patients who underwent hydrophilic IPP implantation. Consecutive cases involving intraoperative 0.05% CHG as an irrigant and/or dip were compared with a similar number of consecutive control cases without 0.05% CHG. The primary outcome was IPP explant for infection. Predictors of infection were assessed with multivariable logistic regression analysis. Exploratory subgroup analyses further characterized specific 0.05% CHG scenarios.

RESULTS: Among 14 participating institutions, 2150 hydrophilic IPP cases were analyzed. Intraoperative 0.05% CHG was associated with a significantly higher rate of infection compared with using antimicrobials as an irrigant and dip (4.6% vs 2.1%, P < .001). Odds of infection were 2.07 times higher with intraoperative 0.05% CHG (CI: 1.37-3.76, P = .002). On subgroup analysis, the incidence of infection with use of 0.05% CHG as irrigant and dip was 4.5% compared with 3.8% when 0.05% CHG irrigation was used with antimicrobial dip. The rate of infection with 0.05% CHG use was 3.5% for primary surgeries and 12% for revision surgeries.

CONCLUSIONS: The use of 0.05% CHG with hydrophilic IPP was associated with an elevated infection rate. For hydrophilic IPP surgery, caution with 0.05% CHG use is warranted pending additional prospective evaluation.