Session: MP62: Sexual Function/Dysfunction: Surgical Therapy I
MP62-05: AUA Recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, not Lower, Risk for Post-operative Infection: A Multicenter Analysis
Introduction: There is limited data on the best antimicrobial prophylaxis for inflatable penile prosthesis (IPP) surgery with minimal guidance from many urologic societies. The AUA provides the most specific recommendation where the AUA Best Practice Statement on Anitmicrobial Prophylaxis recommends the use gentamicin plus vancomycin or a 1st/2nd generation cephalosporin for IPP surgery. We sought to determine if the AUA recommended prophylaxis (vancomycin + gentamicin) for primary IPP surgery is associated with a higher infection risk than non-standard regimens. Methods: We performed a multicenter, retrospective study of patients undergoing primary IPP surgery. Patients were divided into those receiving standard AUA antibiotic prophylaxis (vancomycin + gentamicin) and those receiving any other regimen. Vancomycin plus gentamicin has previously been shown to be more efficacious and more commonly used than cephalosporin plus gentamicin. Therefore, we chose to specifically evaluate vancomycin and gentamicin vs non-standard regimens. 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 and 1,750 received other regimens). The infection rate was similar between groups, 1.0 vs 1.2% for standard vs non-standard prophylaxis. In the multivariate analysis, vancomycin + gentamicin (HR: 2.74, 95%CI: 1.38-5.41, p=0.004) and diabetes (HR: 1.87, 95%CI: 1.03-3.39, p=0.04) were significantly associated with a higher risk of infection. Antifungals (HR: 0.08, 95%CI: 0.03-0.19, p<0.001) were associated with lower risk of infection. In patients of both groups receiving gentamicin as part of perioperative antibiotic prophylaxis, the use of weight-based gentamicin compared to 80 mg gentamicin was associated with similar risk of device explantation due to infection (HR: 2.88, 95% CI: 0.83 to 10, p = 0.1). Conclusions: Vancomycin + gentamicin 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. Tailoring individual regimens to local antibiograms may provide the best infection prevention. SOURCE OF Funding: None
