Barham David W, Pyrgidis Nikolaos, Gross Martin S, Hammad Muhammed, Swerdloff Daniel, Miller Jake, Alkhayal Abdullah, Alrabeeah Khalid A, Andrianne Robert, Burnett Arthur L, Gross Kelli, Hatzichristodoulou Georgios, Hotaling James M, Hsieh Tung-Chin, Jones Adam, Jones James M, Lentz Aaron, Levy Jason, Modgil Vaibhav, Osmonov Daniar, Park Sung Hun, Pearce Ian, Perito Paul, Sadeghi-Nejad Hossein, Sempels Maxime, Suarez-Sarmiento Alfredo, Simhan Jay, van Renterghem Koenraad, Warner J Nicholas, Ziegelmann Matthew, Yafi Faysal A
Department of Urology, University of California, Irvine, Orange, California.
Department of Urology, 'Martha-Maria' Hospital Nuremberg, Nuremberg, Germany.
J Urol. 2023 Feb;209(2):399-409. doi: 10.1097/JU.0000000000003071. Epub 2022 Nov 16.
Our aim was to determine if the AUA-recommended prophylaxis (vancomycin + gentamicin alone) for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard regimens.
We performed a multicenter, retrospective study of patients undergoing primary inflatable penile prosthesis surgery. Patients were divided into those receiving vancomycin + gentamicin alone and those receiving any other regimen. A Cox proportional-hazards model was constructed adjusted for major predictors. A subgroup analysis to identify the appropriate dosage of gentamicin was also performed.
A total of 4,161 patients underwent primary inflatable penile prosthesis placement (2,411 received vancomycin + gentamicin alone and 1,750 received other regimens). The infection rate was similar between groups, 1% vs 1.2% for standard vs nonstandard prophylaxis. In the multivariable analysis, vancomycin + gentamicin (HR: 2.7, 95% CI: 1.4 to 5.4, = .004) and diabetes (HR: 1.9, 95% CI: 1.03 to 3.4, = .04) were significantly associated with a higher risk of infection. Antifungals (HR: 0.08, 95% CI: 0.03 to 0.19, < .001) were associated with lower risk of infection. There was no statistically significant difference in infection rate between weight-based gentamicin compared to 80 mg gentamicin (HR: 2.9, 95% CI: 0.83 to 10, = .1).
Vancomycin + gentamicin alone for antibiotic prophylaxis for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard antibiotic regimens while antifungal use is associated with lower infection risk. A critical review of the recommended antimicrobial prophylactic regimens is needed. Prospective research is needed to further elucidate best practices in inflatable penile prosthesis antimicrobial prophylaxis.
我们的目的是确定美国泌尿外科学会（AUA）推荐的用于初次可膨胀阴茎假体手术的预防方案（仅使用万古霉素+庆大霉素）是否比非标准方案具有更高的感染风险。
我们对接受初次可膨胀阴茎假体手术的患者进行了一项多中心回顾性研究。患者被分为仅接受万古霉素+庆大霉素的患者和接受任何其他方案的患者。构建了一个Cox比例风险模型，并针对主要预测因素进行了调整。还进行了亚组分析以确定庆大霉素的合适剂量。
共有4161例患者接受了初次可膨胀阴茎假体植入（2411例仅接受万古霉素+庆大霉素，1750例接受其他方案）。两组的感染率相似，标准预防与非标准预防的感染率分别为1%和1.2%。在多变量分析中，万古霉素+庆大霉素（风险比：2.7，95%置信区间：1.4至5.4，P = 0.004）和糖尿病（风险比：1.9，95%置信区间：1.03至3.4，P = 0.04）与较高的感染风险显著相关。抗真菌药物（风险比：0.08，95%置信区间：0.03至0.19，P < 0.001）与较低的感染风险相关。基于体重的庆大霉素与80毫克庆大霉素的感染率在统计学上无显著差异（风险比：2.9，95%置信区间：0.83至10，P = 0.1）。
对于初次可膨胀阴茎假体手术，仅使用万古霉素+庆大霉素进行抗生素预防比非标准抗生素方案具有更高的感染风险，而使用抗真菌药物与较低感染风险相关。需要对推荐的抗菌预防方案进行严格审查。需要进行前瞻性研究以进一步阐明可膨胀阴茎假体抗菌预防的最佳实践。
