Presentation Authors: Maxwell Towe*, Linda Huynh, Farouk M. EL-Khatib, Mahdi Osman, Orange, CA, Gregory Barton, Durham, NC, Gregory Broderick, Jacksonville, FL, Arthur L. Burnett, Jeffrey D. Campbell, Baltimore, MD, Jonathan Clavell Hernandez, Houston, TX, Martin Gross, Lebanon, NH, Ross Guillum, Houston, TX, Amy I. Guise, Milwaukee, WI, Georgios Hatzichristodoulou, Würzburg, Germany, Wayne Hellstrom, New Orleans, LA, Gerard D. Henry, Bossier City, LA, Tung-Chin Hsieh, Christopher Koprowski, San Diego, CA, Lawrence C. Jenkins, Columbus, OH, Kook Bin Lee, Seoul, Korea, Republic of, Aaron C. Lentz, Durham, NC, Ricardo M. Munarriz, Boston, MA, Daniar Osmonov, Kiel, Germany, Shu Pan, Boston, MA, Kevin Parikh, Jacksonville, FL, SungHun Park, Seoul, Korea, Republic of, Paul Perito, Coral Gables, FL, Hossein Sadeghi-Nejad, Hackensack, NJ, Amir Shareza Patel, Jay Simhan, Philadelphia, PA, Run Wang, Houston, TX, Faysal A. Yafi, Orange, CA
Introduction: The most devastating complication following penile prosthesis (PP) implantation is an infection requiring device explantation. Current AUA guidelines recommend antibiotic prophylaxis before PPI with an aminoglycoside and either a 1st/2nd generation cephalosporin or vancomycin. We conducted a multi-institutional study to examine infection rates in diabetic patients undergoing PP implantation with different prophylactic antibiotic regimens, and compared outcomes based on adherence to AUA guidelines.
Methods: Between April 2003 and May 2018, data was collected from 15 different institutions, and charts of 710 patients with diabetes receiving primary PP implantation were reviewed. Demographic data including age, race, Body Mass Index (BMI), and type of diabetes were collected for each patient. Pre-operative antibiotic regimen was recorded for each patient and primary outcomes were post-operative infection, explantation, and revision rates. Patients were included in the analysis only if they had complete information regarding perioperative antibiotics and outcomes. Univariate comparisons of proportions were completed for rates of infection, explantation, and revision between different antibiotic regimens.
Results: Overall, 603 patients had complete records and were included in this study. Median follow up was 7 months (range: 0 - 157). The total number of infections, explantations, and revisions for all patients included were 23 (3.8%), 29 (4.8%), and 33 (5.5%), respectively. The AUA prophylaxis guidelines were followed in 282 patients, 220 (36.5%) received Gentamicin + Vancomycin as prophylaxis and 62 (10.3%) received Gentamicin + Cephalosporin (Cefazolin), while 321 (53.2%) received prophylaxis that differed from guidelines. The number of infections in the AUA guidelines group was 17 (6.0%) vs. 6 (1.9%) for the non-AUA guidelines group, p = 0.008. The number of explantations in the AUA guidelines group was 23 (8.2%) vs. 6 (1.9%) in the non-AUA guidelines group, p < 0.001. There was no significant difference in revision rates between the two groups (p = 0.360). On further analysis, the infection rate for patients treated with Gentamicin + Vancomycin (7.73%) dropped significantly when a Quinolone (1.04%) was added to the regimen, p=0.001. Similar reductions were seen with explantation (9.6% to 1.0%, p < 0.001) and revision (8.2% to 3.1%, p = 0.028) rates. Adding an anti-fungal in combination with Gentamicin + Vancomycin non-significantly lowered the infection (0%), explantation (2.9%), and revision (0%) rates.
Conclusions: Adherence to the AUA penile prosthesis antibiotic prophylaxis guidelines confers a higher rate of device infection in diabetic patients. A high rate of infection was noted in patients receiving the most commonly prescribed antibiotic regimen of Gentamicin + Vancomycin. The AUA guidelines should be amended to reflect findings of this and other device infection related studies.