Trends in Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery from A Large National Cohort.

Overview

abstract

OBJECTIVE: To assess changes in antibiotic prophylaxis for inflatable penile prosthesis surgery following publication of the AUA Best Practice Statement in April 2008. 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<0.001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0% of encounters per quarter, R²=0.84, p<0.001) and vancomycin (0.1% to 0.7%, R²=0.77, p<0.001). On multivariable regression, odds of AUA-adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54 - 1.80, p<0.001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07 - 2.35, p<0.01). Non-adherence to an AUA-recommended regimen with use of non-standard antibiotics (OR: 1.16, 95% CI: 0.78 - 1.71, p=0.5) or excess antibiotics (OR: 0.91, 95% CI: 0.62 - 1.30, p=0.6) 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.