Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Can J Urol. 2020 Dec;27(6):10437-10442.
INTRODUCTION We sought to explore whether patients discharged without antibiotics after artificial urinary sphincter (AUS) insertion were more likely to require device explantation for infection or erosion compared to patients discharged with antibiotics at our institution and compared to patients in other large, contemporary series.
AUS insertions performed at our institution between 2013 and 2017 were retrospectively reviewed to determine demographics, comorbidities, and perioperative and medium-term outcomes. Patients were grouped based on 1) known risk factors for infectious complications or erosion and 2) postoperative antibiotic prescription status. Patients were placed in Group 1 if they did not demonstrate risk factors and did not receive postoperative antibiotics, Group 2 if they did possess risk factors but did not receive postoperative antibiotics, and Group 3 if they had risk factors and received postoperative antibiotics.
Of the 155 men who met inclusion criteria, 44, 47, and 64 were categorized in Groups 1, 2, and 3, respectively. Median (IQR) follow up was similar across Groups 1, 2, and 3 (12.7 [4.6-25.1] versus 10.7 [4.5-31.3] versus 8.3 [4.4-26.4] months, p = 0.808). Rates of explantation due to device infection (0 versus 2 versus 6%, p = 0.172) or cuff erosion (2 versus 2 versus 8%, p = 0.253) did not vary significantly between Groups 1-3.
Patients undergoing AUS insertion may be unlikely to benefit from the routine administration of postoperative antibiotics. In light of the known consequences of antibiotic overuse, a randomized controlled trial is warranted.
探讨本中心及其他大型当代系列研究中，接受人工尿道括约肌（AUS）置入术的患者出院时是否未接受抗生素治疗，与接受抗生素治疗的患者相比，因感染或侵蚀而需要取出装置的可能性更高。
回顾性分析 2013 年至 2017 年期间在本机构进行的 AUS 植入术，以确定人口统计学、合并症以及围手术期和中期结果。根据 1）感染并发症或侵蚀的已知危险因素和 2）术后抗生素使用情况，将患者分为三组。无危险因素且未接受术后抗生素治疗的患者归入第 1 组，存在危险因素但未接受术后抗生素治疗的患者归入第 2 组，存在危险因素且接受术后抗生素治疗的患者归入第 3 组。
在符合纳入标准的 155 名男性患者中，44、47 和 64 名患者分别归入第 1、2 和 3 组。第 1、2 和 3 组的中位（IQR）随访时间相似（12.7[4.6-25.1]、10.7[4.5-31.3]和 8.3[4.4-26.4]个月，p=0.808）。因器械感染（0 比 2 比 6%，p=0.172）或袖套侵蚀（2 比 2 比 8%，p=0.253）导致的取出率在第 1-3 组之间无显著差异。
接受 AUS 植入术的患者可能不会从常规术后使用抗生素中获益。鉴于抗生素过度使用的已知后果，有必要进行随机对照试验。
