AUA prophylaxis linked to higher infections, explantation in penile prosthesis surgery in diabetic men

Using the standard American Urological Association (AUA) antibiotic prophylaxis for penile prosthesis surgery among diabetic men with erectile dysfunction results in significantly higher likelihood of postoperative device infection and device explantation compared with nonstandard prophylaxis, suggests a recent study.

“AUA antibiotic prophylaxis recommendations may be insufficient for covering organisms commonly found in penile prosthesis infections,” the authors said.

This multicentre, retrospective cohort study was performed between April 2003 and August 2018 involving diabetic patients undergoing primary penile prosthesis surgery at 18 institutions from the US, Europe, and Korea. The authors assessed the association of antibiotic prophylaxis type with postoperative penile prosthesis infections, device explantations, and revision surgeries.

Of the patients, 391 (48.6 percent) followed the standard AUA antibiotic prophylaxis and 413 (51.4 percent) used nonstandard prophylaxis. These nonstandard antibiotics included vancomycin-gentamycin-fluoroquinolone, clindamycin-fluoroquinolone, and vancomycin-fluoroquinolone among other combinations.

Men who received AUA prophylaxis, compared with nonstandard prophylaxis, had significantly more postoperative device infections (5.6 percent vs 1.9 percent; p<0.01) and explantations (8.3 percent vs 2.0 percent; p<0.001). Use of the AUA prophylaxis also correlated with significantly greater odds of a postoperative device infection (odds ratio [OR], 2.8, 95 percent confidence interval [CI], 1.1–7.3) and explantation (OR, 3.6, 95 percent CI, 1.4–9.1) compared with nonstandard prophylaxis.

“Our study provides a strong rationale for a prospective investigation to establish the most appropriate prophylaxis strategy in penile prosthesis surgery,” the authors said.