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Review
. 2023 Feb;209(2):399-409.
doi: 10.1097/JU.0000000000003071. Epub 2022 Nov 16.

AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis

David W Barham  1 , Nikolaos Pyrgidis  2 , Martin S Gross  3 , Muhammed Hammad  1 , Daniel Swerdloff  4 , Jake Miller  1 , Abdullah Alkhayal  5 , Khalid A Alrabeeah  5 , Robert Andrianne  6 , Arthur L Burnett  7 , Kelli Gross  8 , Georgios Hatzichristodoulou  2 , James M Hotaling  8 , Tung-Chin Hsieh  9 , Adam Jones  10 , James M Jones  3 , Aaron Lentz  11 , Jason Levy  7 , Vaibhav Modgil  10 , Daniar Osmonov  12 , Sung Hun Park  13 , Ian Pearce  10 , Paul Perito  14 , Hossein Sadeghi-Nejad  15 , Maxime Sempels  6 , Alfredo Suarez-Sarmiento Jr  14 , Jay Simhan  4 , Koenraad van Renterghem  16 , J Nicholas Warner  17 , Matthew Ziegelmann  17 , Faysal A Yafi  1
Affiliations
Review

AUA-recommended Antibiotic Prophylaxis for Primary Penile Implantation Results in a Higher, Not Lower, Risk for Postoperative Infection: A Multicenter Analysis

David W Barham et al. J Urol. 2023 Feb.

Abstract

Purpose: Our aim was to determine if the AUA-recommended prophylaxis (vancomycin + gentamicin alone) for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard regimens.

Materials and methods: We performed a multicenter, retrospective study of patients undergoing primary inflatable penile prosthesis 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.

Results: A total of 4,161 patients underwent primary inflatable penile prosthesis 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 nonstandard prophylaxis. In the multivariable analysis, vancomycin + gentamicin (HR: 2.7, 95% CI: 1.4 to 5.4, P = .004) and diabetes (HR: 1.9, 95% CI: 1.03 to 3.4, P = .04) were significantly associated with a higher risk of infection. Antifungals (HR: 0.08, 95% CI: 0.03 to 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).

Conclusions: Vancomycin + gentamicin alone for antibiotic prophylaxis for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard 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 inflatable penile prosthesis antimicrobial prophylaxis.

Keywords: erectile dysfunction; infections; penile prosthesis.

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