(242) Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery: Trends after Publication of the AUA Best Practice Statement

Abstract

Abstract Introduction In April 2008, the American Urological Association (AUA) released a Best Practice Statement on antimicrobial use in urologic surgery, in which the combination of an aminoglycoside with either vancomycin or a 1st/2nd generation cephalosporin was recommended as the preferred antimicrobial regimen for inflatable penile prosthesis (IPP) implantation. This recommendation has come under scrutiny due to weak evidence supporting these combinations. Objective To assess changes in antibiotic prophylaxis for IPP surgery following publication of the AUA Best Practice Statement in April 2008. Methods The Premier Healthcare Database, an all-payer dataset that captures approximately 20% of hospital discharges in the United States, was queried for IPP 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 IPP 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). The risk of 90-day IPP explant was not associated with adherence to an AUA-recommended regimen (OR: 0.94, 95% CI: 0.75 – 1.18, p=0.6). Conclusions Publication of the AUA Best Practice Statement on Antimicrobial Prophylaxis was associated with a subsequent increase in the usage of AUA-recommended antibiotic regimens, with gentamicin and vancomycin being the most frequently used combination. No association was observed between AUA-adherent regimens and risk of 90-day explant. These findings suggest that the AUA Best Practice Statement, among other relevant communications on antimicrobial use at the time, led to significant changes in prophylactic antibiotic choice in IPP surgery, despite the absence of level-1 evidence regarding a superior choice. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Roman Health.