Prophylactic Vancomycin Leads to Fewer Device Removals in Sacral Neuromodulation

Area of Science:

• Urology
• Infectious Disease
• Surgical Outcomes

Background:

• Sacral neuromodulation (SNM) is a treatment for lower urinary tract dysfunction.
• Infectious complications necessitate device removal in 3-11% of SNM cases.
• Optimizing antibiotic prophylaxis may reduce SNM device explantation rates.

Purpose of the Study:

• To investigate the association between preoperative antibiotic selection and the risk of all-cause SNM device removal.
• To identify specific antibiotic classes linked to higher or lower explantation rates.

Main Methods:

• Retrospective cohort analysis of female patients undergoing SNM implantation (2010-2018) using the Health Facts Database (>750 hospitals).
• Logistic regression (univariate and multivariate) to identify factors associated with device removal, including 35 comorbidities and prophylactic antibiotic choice.
• Analysis included 1,433 patients, with 170 (11.9%) experiencing device removal.

Main Results:

• Vancomycin use was associated with significantly lower device removal rates compared to first-generation cephalosporins (OR=3.1), clindamycin (OR=3.2), second/third-generation cephalosporins (OR=3.1), and aminoglycosides (OR=3.1).
• Patients treated in the Northeastern United States had a higher likelihood of device removal (OR=1.9).
• The most common prophylactic antibiotics were first-generation cephalosporins (52.3%), followed by aminoglycosides (13.3%) and fluoroquinolones (13.3%).

Conclusions:

• Vancomycin prophylaxis may be associated with a reduced risk of SNM device removal compared to several other commonly used antibiotics.
• Further prospective studies are warranted to confirm these findings, though the low event rate for removal may pose challenges for trial design.