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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.

Publication ,  Journal Article
Barham, DW; Pyrgidis, N; Gross, MS; Hammad, M; Swerdloff, D; Miller, J; Alkhayal, A; Alrabeeah, KA; Andrianne, R; Burnett, AL; Gross, K ...
Published in: J Urol
February 2023

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.

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Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

February 2023

Volume

209

Issue

2

Start / End Page

399 / 409

Location

United States

Related Subject Headings

  • Vancomycin
  • Urology & Nephrology
  • Retrospective Studies
  • Prospective Studies
  • Postoperative Complications
  • Penile Prosthesis
  • Penile Implantation
  • Multicenter Studies as Topic
  • Male
  • Humans
 

Citation

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Barham, D. W., Pyrgidis, N., Gross, M. S., Hammad, M., Swerdloff, D., Miller, J., … Yafi, F. A. (2023). 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. https://doi.org/10.1097/JU.0000000000003071
Barham, David W., Nikolaos Pyrgidis, Martin S. Gross, Muhammed Hammad, Daniel Swerdloff, Jake Miller, Abdullah Alkhayal, et al. “AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis.J Urol 209, no. 2 (February 2023): 399–409. https://doi.org/10.1097/JU.0000000000003071.
Barham DW, Pyrgidis N, Gross MS, Hammad M, Swerdloff D, Miller J, et al. AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis. J Urol. 2023 Feb;209(2):399–409.
Barham, David W., et al. “AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis.J Urol, vol. 209, no. 2, Feb. 2023, pp. 399–409. Pubmed, doi:10.1097/JU.0000000000003071.
Barham DW, Pyrgidis N, Gross MS, Hammad M, Swerdloff D, Miller J, Alkhayal A, Alrabeeah KA, Andrianne R, Burnett AL, Gross K, Hatzichristodoulou G, Hotaling JM, Hsieh T-C, Jones A, Jones JM, Lentz A, Levy J, Modgil V, Osmonov D, Park SH, Pearce I, Perito P, Sadeghi-Nejad H, Sempels M, Suarez-Sarmiento A, Simhan J, van Renterghem K, Warner JN, Ziegelmann M, Yafi FA. AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis. J Urol. 2023 Feb;209(2):399–409.
Journal cover image

Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

February 2023

Volume

209

Issue

2

Start / End Page

399 / 409

Location

United States

Related Subject Headings

  • Vancomycin
  • Urology & Nephrology
  • Retrospective Studies
  • Prospective Studies
  • Postoperative Complications
  • Penile Prosthesis
  • Penile Implantation
  • Multicenter Studies as Topic
  • Male
  • Humans