Evaluating the Role of Postoperative Oral Antibiotic Administration in Artificial Urinary Sphincter and Inflatable Penile Prosthesis Explantation: A Nationwide Analysis

Melanie A. Adamsky, William R. Boysen, Andrew J. Cohen, Sandra Ham, Roger R. Dmochowski, Sarah F. Faris, Gregory T. Bales, Joshua A. Cohn

Research output: Contribution to journalArticle

Abstract

Objective To determine whether postoperative oral antibiotics are associated with decreased risk of explantation following artificial urinary sphincter (AUS) or inflatable penile prosthesis (IPP) placement. Although frequently prescribed, the role of postoperative oral antibiotics in preventing AUS or IPP explantation is unknown. Materials and Methods We queried the MarketScan database to identify male patients undergoing AUS or IPP placement between 2003 and 2014. The primary end point was device explantation within 3 months of placement. Multivariate regression analysis controlling for clinical risk factors assessed the impact of postoperative oral antibiotic administration on explant rates. Results We identified 10,847 and 3594 men who underwent IPP and AUS placement, respectively, between 2003 and 2014. Postoperative oral antibiotics were prescribed to 60.6% of patients following IPP placement and 61.1% of patients following AUS placement. The most frequently prescribed antibiotics were fluoroquinolones (35.6%), cephalexin (17.7%), trimethoprim/sulfamethoxazole (7.0%), and amoxicillin-clavulanate (3.2%). Explant rates did not differ based upon receipt of oral antibiotics (antibiotics vs no antibiotics: IPP: 2.2% vs 1.9%, P =.18, AUS: 3.9% vs 4.0%, P =.94). On multivariate analysis, no individual class of antibiotic was associated with decreased odds of device explantation. Conclusion Postoperative oral antibiotics are prescribed to nearly two-thirds of patients but are not associated with reduced odds of explant following IPP or AUS placement. Given the risks to individuals associated with use of antibiotics and increasing bacterial resistance, the role of oral antibiotics after prosthetic placement should be reconsidered and further studied in a prospective fashion.

Original languageEnglish (US)
Pages (from-to)92-98
Number of pages7
JournalUrology
Volume111
DOIs
StatePublished - Jan 2018
Externally publishedYes

Fingerprint

Artificial Urinary Sphincter
Penile Prosthesis
Oral Administration
Anti-Bacterial Agents
Multivariate Analysis
Bacterial Drug Resistance
Cephalexin
Equipment and Supplies
Clavulanic Acid
Fluoroquinolones
Amoxicillin
Sulfamethoxazole Drug Combination Trimethoprim

ASJC Scopus subject areas

  • Urology

Cite this

Evaluating the Role of Postoperative Oral Antibiotic Administration in Artificial Urinary Sphincter and Inflatable Penile Prosthesis Explantation : A Nationwide Analysis. / Adamsky, Melanie A.; Boysen, William R.; Cohen, Andrew J.; Ham, Sandra; Dmochowski, Roger R.; Faris, Sarah F.; Bales, Gregory T.; Cohn, Joshua A.

In: Urology, Vol. 111, 01.2018, p. 92-98.

Research output: Contribution to journalArticle

Adamsky, Melanie A. ; Boysen, William R. ; Cohen, Andrew J. ; Ham, Sandra ; Dmochowski, Roger R. ; Faris, Sarah F. ; Bales, Gregory T. ; Cohn, Joshua A. / Evaluating the Role of Postoperative Oral Antibiotic Administration in Artificial Urinary Sphincter and Inflatable Penile Prosthesis Explantation : A Nationwide Analysis. In: Urology. 2018 ; Vol. 111. pp. 92-98.
@article{cfd5ecc6377044b0ae91f3110c9e2485,
title = "Evaluating the Role of Postoperative Oral Antibiotic Administration in Artificial Urinary Sphincter and Inflatable Penile Prosthesis Explantation: A Nationwide Analysis",
abstract = "Objective To determine whether postoperative oral antibiotics are associated with decreased risk of explantation following artificial urinary sphincter (AUS) or inflatable penile prosthesis (IPP) placement. Although frequently prescribed, the role of postoperative oral antibiotics in preventing AUS or IPP explantation is unknown. Materials and Methods We queried the MarketScan database to identify male patients undergoing AUS or IPP placement between 2003 and 2014. The primary end point was device explantation within 3 months of placement. Multivariate regression analysis controlling for clinical risk factors assessed the impact of postoperative oral antibiotic administration on explant rates. Results We identified 10,847 and 3594 men who underwent IPP and AUS placement, respectively, between 2003 and 2014. Postoperative oral antibiotics were prescribed to 60.6{\%} of patients following IPP placement and 61.1{\%} of patients following AUS placement. The most frequently prescribed antibiotics were fluoroquinolones (35.6{\%}), cephalexin (17.7{\%}), trimethoprim/sulfamethoxazole (7.0{\%}), and amoxicillin-clavulanate (3.2{\%}). Explant rates did not differ based upon receipt of oral antibiotics (antibiotics vs no antibiotics: IPP: 2.2{\%} vs 1.9{\%}, P =.18, AUS: 3.9{\%} vs 4.0{\%}, P =.94). On multivariate analysis, no individual class of antibiotic was associated with decreased odds of device explantation. Conclusion Postoperative oral antibiotics are prescribed to nearly two-thirds of patients but are not associated with reduced odds of explant following IPP or AUS placement. Given the risks to individuals associated with use of antibiotics and increasing bacterial resistance, the role of oral antibiotics after prosthetic placement should be reconsidered and further studied in a prospective fashion.",
author = "Adamsky, {Melanie A.} and Boysen, {William R.} and Cohen, {Andrew J.} and Sandra Ham and Dmochowski, {Roger R.} and Faris, {Sarah F.} and Bales, {Gregory T.} and Cohn, {Joshua A.}",
year = "2018",
month = "1",
doi = "10.1016/j.urology.2017.07.064",
language = "English (US)",
volume = "111",
pages = "92--98",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Evaluating the Role of Postoperative Oral Antibiotic Administration in Artificial Urinary Sphincter and Inflatable Penile Prosthesis Explantation

T2 - A Nationwide Analysis

AU - Adamsky, Melanie A.

AU - Boysen, William R.

AU - Cohen, Andrew J.

AU - Ham, Sandra

AU - Dmochowski, Roger R.

AU - Faris, Sarah F.

AU - Bales, Gregory T.

AU - Cohn, Joshua A.

PY - 2018/1

Y1 - 2018/1

N2 - Objective To determine whether postoperative oral antibiotics are associated with decreased risk of explantation following artificial urinary sphincter (AUS) or inflatable penile prosthesis (IPP) placement. Although frequently prescribed, the role of postoperative oral antibiotics in preventing AUS or IPP explantation is unknown. Materials and Methods We queried the MarketScan database to identify male patients undergoing AUS or IPP placement between 2003 and 2014. The primary end point was device explantation within 3 months of placement. Multivariate regression analysis controlling for clinical risk factors assessed the impact of postoperative oral antibiotic administration on explant rates. Results We identified 10,847 and 3594 men who underwent IPP and AUS placement, respectively, between 2003 and 2014. Postoperative oral antibiotics were prescribed to 60.6% of patients following IPP placement and 61.1% of patients following AUS placement. The most frequently prescribed antibiotics were fluoroquinolones (35.6%), cephalexin (17.7%), trimethoprim/sulfamethoxazole (7.0%), and amoxicillin-clavulanate (3.2%). Explant rates did not differ based upon receipt of oral antibiotics (antibiotics vs no antibiotics: IPP: 2.2% vs 1.9%, P =.18, AUS: 3.9% vs 4.0%, P =.94). On multivariate analysis, no individual class of antibiotic was associated with decreased odds of device explantation. Conclusion Postoperative oral antibiotics are prescribed to nearly two-thirds of patients but are not associated with reduced odds of explant following IPP or AUS placement. Given the risks to individuals associated with use of antibiotics and increasing bacterial resistance, the role of oral antibiotics after prosthetic placement should be reconsidered and further studied in a prospective fashion.

AB - Objective To determine whether postoperative oral antibiotics are associated with decreased risk of explantation following artificial urinary sphincter (AUS) or inflatable penile prosthesis (IPP) placement. Although frequently prescribed, the role of postoperative oral antibiotics in preventing AUS or IPP explantation is unknown. Materials and Methods We queried the MarketScan database to identify male patients undergoing AUS or IPP placement between 2003 and 2014. The primary end point was device explantation within 3 months of placement. Multivariate regression analysis controlling for clinical risk factors assessed the impact of postoperative oral antibiotic administration on explant rates. Results We identified 10,847 and 3594 men who underwent IPP and AUS placement, respectively, between 2003 and 2014. Postoperative oral antibiotics were prescribed to 60.6% of patients following IPP placement and 61.1% of patients following AUS placement. The most frequently prescribed antibiotics were fluoroquinolones (35.6%), cephalexin (17.7%), trimethoprim/sulfamethoxazole (7.0%), and amoxicillin-clavulanate (3.2%). Explant rates did not differ based upon receipt of oral antibiotics (antibiotics vs no antibiotics: IPP: 2.2% vs 1.9%, P =.18, AUS: 3.9% vs 4.0%, P =.94). On multivariate analysis, no individual class of antibiotic was associated with decreased odds of device explantation. Conclusion Postoperative oral antibiotics are prescribed to nearly two-thirds of patients but are not associated with reduced odds of explant following IPP or AUS placement. Given the risks to individuals associated with use of antibiotics and increasing bacterial resistance, the role of oral antibiotics after prosthetic placement should be reconsidered and further studied in a prospective fashion.

UR - http://www.scopus.com/inward/record.url?scp=85033237244&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85033237244&partnerID=8YFLogxK

U2 - 10.1016/j.urology.2017.07.064

DO - 10.1016/j.urology.2017.07.064

M3 - Article

C2 - 28964819

AN - SCOPUS:85033237244

VL - 111

SP - 92

EP - 98

JO - Urology

JF - Urology

SN - 0090-4295

ER -