Abstract
Objective
To assess changes in antibiotic prophylaxis for inflatable penile prosthesis surgery
following publication of the American Urological Association (AUA) Best Practice Statement
in April 2008.
Materials and Methods
The Premier Healthcare Database was queried for inflatable penile prosthesis surgeries
from January 2000 to March 2020. The primary outcome was administration of an AUA-adherent
antimicrobial regimen and secondary outcome was 90-day explant. Piecewise linear regression
was used to compare antimicrobial trends before vs after guideline publication. Multivariable
logistic regression models were constructed for primary and secondary outcomes.
Results
A total of 26,574 patients who underwent inflatable penile prosthesis surgery were
identified, of whom 17,754 (67%) received AUA-adherent antibiotics. After guideline
publication, there was a 42% relative increase in AUA-adherent regimen usage, with
an increase in the usage trend on piecewise linear regression (from 0.1% to 0.8% of
encounters per quarter, R2 = 0.75, P < .001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0%
of encounters per quarter, R2 = 0.84, P < .001) and vancomycin (0.1%-0.7%, R2 = 0.77, P < .001). On multivariable regression, odds of AUA-adherence increased after guideline
publication (OR: 1.67, 95% CI: 1.54-1.80, P < .001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07-2.35, P < .01). Nonadherence to an AUA-recommended regimen with use of nonstandard antibiotics
(OR: 1.16, 95% CI: 0.78-1.71, P = .5) or excess antibiotics (OR: 0.91, 95% CI: 0.62-1.30, P = .6) was not independently associated with increased risk of 90-day explant.
Conclusions
Publication of the AUA Best Practice Statement was associated with subsequent increases
in the usage of guideline-adherent antibiotic regimens, particularly vancomycin and
gentamicin, despite absence of level-1 evidence supporting this combination.
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Article info
Publication history
Published online: November 26, 2022
Accepted:
November 13,
2022
Received:
August 23,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Financial Disclosure: Nahid Punjani was supported by the Theresa and Wallace.Fund of the New York Community Trust. Jonathan Shoag is supported by the Frederick J. and Theresa Dow Fund of the New York Community Trust, the Vinney Scholars Award, and a Damon Runyon Cancer Research Foundation Physician Scientist Training Award. The work presented here was not directly funded by an outside organization or sponsor. The authors of this manuscript have no financial interests or relationships relevant to the content of this manuscript.
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