American Urological Association (AUA) antibiotic prophylaxis recommendations may be insufficient for covering organisms commonly found in penile prosthesis infections. The purpose of this study was to assess the difference between AUA-recommended antibiotic prophylaxis and non-standard prophylaxis in preventing device infections in penile prosthesis surgery performed in diabetics.
A multicenter, retrospective cohort study of diabetic patients undergoing primary penile prosthesis surgery was performed between April 2003 and August 2018. Eighteen institutions from the United States, Europe and Korea contributed. The association between antibiotic prophylaxis type and postoperative penile prosthesis infections, device explantations, and revision surgeries was assessed.
Standard AUA antibiotic prophylaxis was followed in 48.6% (n=391) of cases, while non-standard prophylaxis was used in 51.4% (n=413). Common non-standard antibiotic prophylaxis included Vancomycin-Gentamycin- Fluoroquinolone, Clindamycin-Fluoroquinolone, and Vancomycin-Fluoroquinolone among other combinations. Patients who received AUA prophylaxis had significantly more postoperative device infections (5.6% vs. 1.9%, p<0.01) and explantations (8.3% vs. 2.0%, p<0.001) compared to those who received non-standard prophylaxis. Patients who received AUA prophylaxis had significantly higher odds of a postoperative device infection (OR: 2.8, 95% CI 1.1-7.3) and explantation (OR: 3.6, 95% CI 1.4-9.1) compared to those who received non-standard prophylaxis.
Diabetic men with ED who received standard AUA prophylaxis for penile prosthesis surgery had significantly greater odds of experiencing a postoperative device infection and device explantation compared to patients who received non-standard prophylaxis. Our study provides a strong rationale for a prospective investigation to establish the most appropriate prophylaxis strategy in penile prosthesis surgery.
The Journal of urology. 2020 Jun 10 [Epub ahead of print]
Michael E Rezaee, Maxwell Towe, Mohamad M Osman, Linda M Huynh, Farouk M El-Khatib, Robert Andrianne, Gregory Broderick, Arthur L Burnett, Martin S Gross, Amy I Guise, Georgios Hatzichristodoulou, Gerard D Henry, Jonathan Clavell-Hernandez, Tung-Chin Hsieh, Lawrence C Jenkins, Aaron Lentz, Ricardo M Munarriz, Daniar Osmonov, Sung Hun Park, Paul Perito, Hossein Sadeghi-Nejad, Maxime Sempels, Jay Simhan, Run Wang, Faysal A Yafi
Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire., Department of Urology, University of California, Irvine Medical Center, Orange, California., Service d'urologie, Centre Hospitalier Universitaire de Liege, Liege, Belgium., Department of Urology, Mayo Clinic, Jacksonville, Florida., The Johns Hopkins Hospital, Baltimore, Maryland., Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin., Department of Urology, Julius-Maximilians-University of Wurzburg, Wurzburg, Germany., ArkLaTex Urology, Bossier City, Louisiana., University of Texas, MD Anderson Cancer Center, Houston, Texas., Department of Urology, UC San Diego Health System, San Diego, California., Department of Urology, The Ohio State University, Columbus, Ohio., Division of Urology, Duke University Medical Center, Durham, North Carolina., Department of Urology, Boston University Medical Center, Boston, Massachusetts., Department of Urology, University Hospital Schleswig Holstein, Campus Kiel, Germany., Sewum Prosthetic Urology Center of Excellence, Seoul, South Korea., Perito Urology, Coral Cables, Florida., Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey., Einstein Healthcare Network, Fox Chase Cancer Center, Department of Urology, Philadelphia, Pennsylvania.