EAU 2019: Adherence to the AUA Penile Prosthesis Antibiotic Prophylaxis Guidelines in Diabetic Patients is Associated with Significantly Higher Risks of Device Infection

Barcelona, Spain (UroToday.com) Perioperative antibiotic prophylaxis and method of delivery is a highly controversial and surgeon-dependent practice. While it is highly recommended that patients undergoing inflatable penile prosthesis implantation are prescribed antibiotics to prevent postoperative infection, there is no agreed-upon standard as to which antibiotics are most recommended. 

Maxwell Towe, a clinical research fellow from the University of California, Irvine presented his group’s study on AUA guidelines for penile prosthesis antibiotic prophylaxis. His study is the largest study currently reported, with approximately 700 diabetic patients from 15 centers internationally. 

Towe notes their previous study, showing that even in diabetic patients at increased risk for infection following surgery, their infections rates were only 3.8% in the entire cohort. However, even with this infection rate, he states that his group saw an increased risk of poor outcomes when patients were prescribed antibiotics via the AUA guidelines. 

After controlling for patient indicators of infection (i.e. age of patients, body mass index, preoperative hemoglobin, and preoperative blood glucose), patients prescribed antibiotic prophylaxis according to AUA guidelines were independently at increased risk for infection. Towe asserts three possibilities for this correlation: first, AUA antibiotic regimes do not have as broad as coverage as other regimes, specifically for fungal and aerobic bacteria; and, second, the increase in antibiotic-resistant infections, particularly due to the rise of antibiotic-impregnated device implants. He proposes that those utilizing the AUA guidelines should incorporate fungal and aerobic coverage into their regiments. 

Finally, Towe mentions his group’s continued efforts with this project. Of the 15 institutions providing data to the study, he states that the group will be collecting culture data of patients with post-implant infection. Preliminarily, he states that approximately one-third of the cultures have contained fungal and aerobic bacteria – another cause to support his previous call for broader antibiotic coverage. 

Presented by: Maxwell Towe, Prostate Cancer and Men's Health Fellow, University of California, Irvine, Department of Urology, Orange, United States 

Written by: Linda My Huynh, a Senior Clinical Research Coordinator (Department of Urology, University of California-Irvine) and medical writer for UroToday.com.  at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.