The following is a summary of “Trends in Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery From a Large National Cohort,” published in the FEBRUARY 2023 issue of Urology by Brant, et al.
For a study, researchers sought to evaluate changes in antibiotic prophylaxis for inflatable penile prosthesis surgery after the publication of the American Urological Association (AUA) Best Practice Statement in April 2008.
Data were obtained from the Premier Healthcare Database for inflatable penile prosthesis surgeries performed between January 2000 and March 2020. The study’s primary outcome was using an AUA-adherent antimicrobial regimen, and the secondary outcome was a 90-day explant. Piecewise linear regression was used to compare antimicrobial trends before and after the guideline’s publication. In addition, multivariable logistic regression models were developed for primary and secondary outcomes.
Of the 26,574 patients who underwent inflatable penile prosthesis surgery, 67% (n = 17,754) received AUA-adherent antibiotics. After the guideline’s publication, there was a 42% relative increase in the usage of AUA-adherent regimen, with a rise in the trend of use on piecewise linear regression (from 0.1% to 0.8% of encounters per quarter, R2 = 0.75, P < .001). The usage trends for gentamicin and vancomycin also increased (from 0.0% to 1.0% of encounters per quarter, R2 = 0.84, P < .001, and 0.1% to 0.7%, R2= 0.77, P < .001, respectively). Multivariable regression showed that the odds of AUA adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54-1.80, P < .001) and with surgery performed by a high-volume surgeon (OR: 2.21, 95% CI: 2.07-2.35, P < .01). Nonadherence to an AUA-recommended regimen with nonstandard antibiotics (OR: 1.16, 95% CI: 0.78-1.71, P = .5) or excessive antibiotics (OR: 0.91, 95% CI: 0.62-1.30, P = .6) was not independently associated with an increased risk of 90-day explant.
The publication of the AUA Best Practice Statement led to an increase in guideline-adherent antibiotic regimens for inflatable penile prosthesis surgeries, particularly for vancomycin and gentamicin, despite the lack of level-1 evidence supporting this combination.
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