AUA Recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Post-operative Infection: A Multicenter Analysis.

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.

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.

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).

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.

The Journal of urology. 2022 Nov 16 [Epub ahead of print]

David W Barham, Nikolaos Pyrgidis, Martin S Gross, Muhammed Hammad, Daniel Swerdloff, Jake Miller, Abdullah Alkhayal, Khalid A Alrabeeah, Robert Andrianne, Arthur L Burnett, Kelli Gross, Georgios Hatzichristodoulou, James M Hotaling, Tung-Chin Hsieh, Adam Jones, James M Jones, Aaron Lentz, Jason Levy, Vaibhav Modgil, Daniar Osmonov, Sung Hun Park, Ian Pearce, Paul Perito, Hossein Sadeghi-Nejad, Maxime Sempels, Alfredo Suarez-Sarmiento, Jay Simhan, Koenraad van Renterghem, J Nicholas Warner, Matthew Ziegelmann, Faysal A Yafi

Department of Urology, University of California, Irvine, Orange, California., Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany., Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire., Department of Urology/Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Division of Urology, Department of Surgery, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia., Service d'urologie, Centre Hospitalier Universitaire de Liege, Liege, Belgium., Department of Urology, Johns Hopkins University, Baltimore, Maryland., Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah., Department of Urology, University of California, San Diego, La Jolla, California., Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK., Department of Urology, Duke University, Durham, North Carolina., Department of Urology, University Hospital Schleswig Holstein, Kiel, Germany., Sewum Prosthetic Urology Center of Excellence, Seoul, South Korea., Perito Urology, Coral Gables, Florida., Division of Urology, Rutgers New Jersey Medical School, Newark, New Jersey., Department of Urology, Jessa Hospital, Hasselt, Belgium., Department of Urology, Mayo Clinic, Rochester, Minnesota.

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