J Urol. 2022 Nov 16:101097JU0000000000003071. doi: 10.1097/JU.0000000000003071. Online ahead of print.
ABSTRACT
PURPOSE: To determine if the AUA recommended prophylaxis (vancomycin + gentamicin alone) for primary inflatable penile prosthesis (IPP) surgery is associated with a higher infection risk than non-standard regimens.
MATERIALS AND METHODS: We performed a multicenter, retrospective study of patients undergoing primary IPP 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: 4,161 patients underwent primary IPP 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 non-standard prophylaxis. In the multivariable analysis, vancomycin + gentamicin (HR: 2.7, 95%CI: 1.4-5.4, P = .004) and diabetes (HR: 1.9, 95%CI: 1.03-3.4, P = .04) were significantly associated with a higher risk of infection. Antifungals (HR: 0.08, 95%CI: 0.03-0.19, 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 IPP surgery is associated with a higher infection risk than non-standard 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 IPP antimicrobial prophylaxis.
PMID:36383789 | DOI:10.1097/JU.0000000000003071
