Trends in Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery From a Large National Cohort

Aaron Brant; Patrick Lewicki; Nahid Punjani; Caroline Kang; Jessica Marinaro; Michael Callegari; Megan Prunty; Nannan Thirumavalavan; Joshua A. Halpern; Jonathan E. Shoag; James A. Kashanian

doi:10.1016/j.urology.2022.11.010

Trends in Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery From a Large National Cohort

Aaron Brant, Patrick Lewicki, Nahid Punjani, Caroline Kang, Jessica Marinaro, Michael Callegari, Megan Prunty, Nannan Thirumavalavan, Joshua A. Halpern, Jonathan E. Shoag, James A. Kashanian^*

^*Corresponding author for this work

Urology

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Objective: To assess changes in antibiotic prophylaxis for inflatable penile prosthesis surgery following publication of the American Urological Association (AUA) Best Practice Statement in April 2008. Materials and Methods: The Premier Healthcare Database was queried for inflatable penile prosthesis 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 inflatable penile prosthesis 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 < .001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0% of encounters per quarter, R² = 0.84, P < .001) and vancomycin (0.1%-0.7%, R² = 0.77, P < .001). On multivariable regression, odds of AUA-adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54-1.80, P < .001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07-2.35, P < .01). Nonadherence to an AUA-recommended regimen with use of nonstandard antibiotics (OR: 1.16, 95% CI: 0.78-1.71, P = .5) or excess antibiotics (OR: 0.91, 95% CI: 0.62-1.30, P = .6) was not independently associated with increased risk of 90-day explant. Conclusions: Publication of the AUA Best Practice Statement was associated with subsequent increases in the usage of guideline-adherent antibiotic regimens, particularly vancomycin and gentamicin, despite absence of level-1 evidence supporting this combination.

Original language	English (US)
Pages (from-to)	131-137
Number of pages	7
Journal	Urology
Volume	172
DOIs	https://doi.org/10.1016/j.urology.2022.11.010
State	Published - Feb 2023

Funding

Financial Disclosure: Nahid Punjani was supported by the Theresa and Wallace.Fund of the New York Community Trust. Jonathan Shoag is supported by the Frederick J. and Theresa Dow Fund of the New York Community Trust, the Vinney Scholars Award, and a Damon Runyon Cancer Research Foundation Physician Scientist Training Award. The work presented here was not directly funded by an outside organization or sponsor. The authors of this manuscript have no financial interests or relationships relevant to the content of this manuscript.

ASJC Scopus subject areas

Urology

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10.1016/j.urology.2022.11.010

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@article{234b36a5e37a40d4bc5d2b9df1ba988c,

title = "Trends in Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery From a Large National Cohort",

abstract = "Objective: To assess changes in antibiotic prophylaxis for inflatable penile prosthesis surgery following publication of the American Urological Association (AUA) Best Practice Statement in April 2008. Materials and Methods: The Premier Healthcare Database was queried for inflatable penile prosthesis 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 inflatable penile prosthesis 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 < .001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0% of encounters per quarter, R2 = 0.84, P < .001) and vancomycin (0.1%-0.7%, R2 = 0.77, P < .001). On multivariable regression, odds of AUA-adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54-1.80, P < .001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07-2.35, P < .01). Nonadherence to an AUA-recommended regimen with use of nonstandard antibiotics (OR: 1.16, 95% CI: 0.78-1.71, P = .5) or excess antibiotics (OR: 0.91, 95% CI: 0.62-1.30, P = .6) was not independently associated with increased risk of 90-day explant. Conclusions: Publication of the AUA Best Practice Statement was associated with subsequent increases in the usage of guideline-adherent antibiotic regimens, particularly vancomycin and gentamicin, despite absence of level-1 evidence supporting this combination.",

author = "Aaron Brant and Patrick Lewicki and Nahid Punjani and Caroline Kang and Jessica Marinaro and Michael Callegari and Megan Prunty and Nannan Thirumavalavan and Halpern, {Joshua A.} and Shoag, {Jonathan E.} and Kashanian, {James A.}",

note = "Funding Information: Financial Disclosure: Nahid Punjani was supported by the Theresa and Wallace.Fund of the New York Community Trust. Jonathan Shoag is supported by the Frederick J. and Theresa Dow Fund of the New York Community Trust, the Vinney Scholars Award, and a Damon Runyon Cancer Research Foundation Physician Scientist Training Award. The work presented here was not directly funded by an outside organization or sponsor. The authors of this manuscript have no financial interests or relationships relevant to the content of this manuscript. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2023",

month = feb,

doi = "10.1016/j.urology.2022.11.010",

language = "English (US)",

volume = "172",

pages = "131--137",

journal = "Urology",

issn = "0090-4295",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Trends in Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery From a Large National Cohort

AU - Brant, Aaron

AU - Lewicki, Patrick

AU - Punjani, Nahid

AU - Kang, Caroline

AU - Marinaro, Jessica

AU - Callegari, Michael

AU - Prunty, Megan

AU - Thirumavalavan, Nannan

AU - Halpern, Joshua A.

AU - Shoag, Jonathan E.

AU - Kashanian, James A.

N1 - Funding Information: Financial Disclosure: Nahid Punjani was supported by the Theresa and Wallace.Fund of the New York Community Trust. Jonathan Shoag is supported by the Frederick J. and Theresa Dow Fund of the New York Community Trust, the Vinney Scholars Award, and a Damon Runyon Cancer Research Foundation Physician Scientist Training Award. The work presented here was not directly funded by an outside organization or sponsor. The authors of this manuscript have no financial interests or relationships relevant to the content of this manuscript. Publisher Copyright: © 2022 Elsevier Inc.

PY - 2023/2

Y1 - 2023/2

N2 - Objective: To assess changes in antibiotic prophylaxis for inflatable penile prosthesis surgery following publication of the American Urological Association (AUA) Best Practice Statement in April 2008. Materials and Methods: The Premier Healthcare Database was queried for inflatable penile prosthesis 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 inflatable penile prosthesis 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 < .001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0% of encounters per quarter, R2 = 0.84, P < .001) and vancomycin (0.1%-0.7%, R2 = 0.77, P < .001). On multivariable regression, odds of AUA-adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54-1.80, P < .001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07-2.35, P < .01). Nonadherence to an AUA-recommended regimen with use of nonstandard antibiotics (OR: 1.16, 95% CI: 0.78-1.71, P = .5) or excess antibiotics (OR: 0.91, 95% CI: 0.62-1.30, P = .6) was not independently associated with increased risk of 90-day explant. Conclusions: Publication of the AUA Best Practice Statement was associated with subsequent increases in the usage of guideline-adherent antibiotic regimens, particularly vancomycin and gentamicin, despite absence of level-1 evidence supporting this combination.

AB - Objective: To assess changes in antibiotic prophylaxis for inflatable penile prosthesis surgery following publication of the American Urological Association (AUA) Best Practice Statement in April 2008. Materials and Methods: The Premier Healthcare Database was queried for inflatable penile prosthesis 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 inflatable penile prosthesis 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 < .001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0% of encounters per quarter, R2 = 0.84, P < .001) and vancomycin (0.1%-0.7%, R2 = 0.77, P < .001). On multivariable regression, odds of AUA-adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54-1.80, P < .001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07-2.35, P < .01). Nonadherence to an AUA-recommended regimen with use of nonstandard antibiotics (OR: 1.16, 95% CI: 0.78-1.71, P = .5) or excess antibiotics (OR: 0.91, 95% CI: 0.62-1.30, P = .6) was not independently associated with increased risk of 90-day explant. Conclusions: Publication of the AUA Best Practice Statement was associated with subsequent increases in the usage of guideline-adherent antibiotic regimens, particularly vancomycin and gentamicin, despite absence of level-1 evidence supporting this combination.

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UR - http://www.scopus.com/inward/citedby.url?scp=85144573273&partnerID=8YFLogxK

U2 - 10.1016/j.urology.2022.11.010

DO - 10.1016/j.urology.2022.11.010

M3 - Article

C2 - 36450316

AN - SCOPUS:85144573273

SN - 0090-4295

VL - 172

SP - 131

EP - 137

JO - Urology

JF - Urology

ER -

Trends in Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery From a Large National Cohort

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