Penile Prosthesis Insertion in the Era of Antibiotic Stewardship-Are Postoperative Antibiotics Necessary?
Benjamin M Dropkin1, Leah P Chisholm2, Jeremiah D Dallmer2
1Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
Purpose:
We sought to determine whether patients discharged from the hospital without antibiotics after inflatable penile prosthesis insertion were at increased risk for infectious complications compared to patients at our institution discharged with oral antibiotics and patients in other contemporary series.
Materials And Methods:
We reviewed the medical records of patients who underwent inflatable penile prosthesis insertion from 2013 through 2017. Group 1 patients had no risk factors for infectious complications and did not receive postoperative antibiotics. Group 2 patients had risk factors for infectious complications but did not receive postoperative antibiotics. Group 3 patients had risk factors for infectious complications and received postoperative antibiotics.
Results:
Of the 222 men who met study inclusion criteria 88 (40%) were in group 1, 48 (21%) were in group 2 and 86 (39%) were in group 3. The mean ± SD number of risk factors for infection was lower in group 2 than in group 3 (1.08 ± 0.28 vs 1.24 ± 0.46, p = 0.013). Median followup did not vary among groups 1, 2 and 3 (4.6 months, IQR 1.8-7.2; 3.5, IQR 1.4-6.9; and 4.5, IQR 1.4-7.4; p = 0.146, respectively). Rates of explantation due to device infection (0% vs 4% vs 5%, p = 0.130) and nonoperative infectious complications (1% vs 2% vs 2%, p = 0.829) did not vary among groups 1 to 3, respectively.
Conclusions:
Patients who undergo inflatable penile prosthesis insertion appeared unlikely to benefit from routine administration of postoperative antibiotics. In the current era of antibiotic stewardship these findings have the potential for substantial individual and population health benefits.
Insights
Discontinuing routine postoperative antibiotics after inflatable penile prosthesis insertion is safe. This approach aligns with antibiotic stewardship and offers significant health benefits.
Area of Science:
- Urology
- Infectious Disease
- Surgical Outcomes
Background:
- Infection is a significant complication following penile prosthesis surgery.
- Current practices often include routine postoperative antibiotics, but evidence for their necessity is debated.
- Antibiotic stewardship initiatives encourage minimizing unnecessary antibiotic use.
Purpose of the Study:
- To evaluate the risk of infectious complications in patients undergoing inflatable penile prosthesis (IPP) insertion who were discharged without antibiotics.
- To compare outcomes between patients discharged without antibiotics and those receiving oral antibiotics post-surgery.
- To assess infection rates in comparison to contemporary series.
Main Methods:
- Retrospective review of 222 patients who underwent IPP insertion between 2013 and 2017.
- Patients were categorized into three groups: no risk factors/no antibiotics, risk factors/no antibiotics, and risk factors/antibiotics.
- Infection rates, explantation due to infection, and nonoperative infectious complications were analyzed.
Main Results:
- No significant difference in explantation rates due to device infection (0% vs 4% vs 5%) or nonoperative infectious complications (1% vs 2% vs 2%) was observed among the three groups.
- Follow-up duration did not significantly differ across the groups.
- Patients with risk factors receiving antibiotics had a slightly higher mean number of risk factors compared to those without antibiotics.
Conclusions:
- Routine postoperative antibiotics after inflatable penile prosthesis insertion do not appear to confer additional benefit in preventing infectious complications.
- Discharging patients without routine postoperative antibiotics is a viable strategy.
- These findings support antibiotic stewardship by reducing unnecessary antibiotic exposure.
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