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      Post-operative antibiotics following placement of a penile prosthesis

      editorial
      1 , 2 ,
      Translational Andrology and Urology
      AME Publishing Company

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          Abstract

          One of the most devastating complications that can occur following a penile prosthesis is infectious in nature (1,2). Consequently, both proper patient selection and risk management are essential for prosthetic surgeons. In a recent paper by Palma-Zamora et al. (1) published in the current issue of Translational Andrology and Urology, the authors present data discussing the short-term (30-day) adverse outcomes that can occur post placement of a penile prosthesis. The authors identified an overall 30-day complication rate of 11%; of which 45% were infectious in etiology (1). Diabetes was present in 29% of patients (1) and although there is some debate regarding the importance of hemoglobin A1c in diabetic patients undergoing prosthesis placement, optimizing peri-operative glucose control for all diabetic patients is essential in reducing the risk of infectious complications (3,4). Given the significant consequences of infection, a brief discussion regarding post-operative antibiotic usage is warranted. In a 2013 consensus statement of 16 top prosthetic surgeons, anywhere from 5–14 days of post-operative oral antibiotics was preferred (5). A multitude of different oral antibiotics were used including quinolones, cephalosporins, penicillins and sulfa drugs (5). In geographic regions where methicillin-resistant Staphylococcus aureus (MRSA) was prevalent, the consensus was to use trimethoprim-sulfamethoxazole (Bactrim) or, in cases of sulfa drug allergy, doxycycline (5). Unfortunately, given the current state of research and methodological challenges, expert opinion is the best level of evidence available. While no randomized controlled trials to support this practice, recent case reports and small retrospective studies have found success in managing even local infections with conservative measures that include oral antibiotics (6,7). At the present time, although further study is required, the use of post-operative prophylactic antibiotic usage is justified.

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          Most cited references7

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          Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis.

          OBJECTIVE To determine the independent association between diabetes and surgical site infection (SSI) across multiple surgical procedures. DESIGN Systematic review and meta-analysis. METHODS Studies indexed in PubMed published between December 1985 and through July 2015 were identified through the search terms "risk factors" or "glucose" and "surgical site infection." A total of 3,631 abstracts were identified through the initial search terms. Full texts were reviewed for 522 articles. Of these, 94 articles met the criteria for inclusion. Standardized data collection forms were used to extract study-specific estimates for diabetes, blood glucose levels, and body mass index (BMI). A random-effects meta-analysis was used to generate pooled estimates, and meta-regression was used to evaluate specific hypothesized sources of heterogeneity. RESULTS The primary outcome was SSI, as defined by the Centers for Disease Control and Prevention surveillance criteria. The overall effect size for the association between diabetes and SSI was odds ratio (OR)=1.53 (95% predictive interval [PI], 1.11-2.12; I2, 57.2%). SSI class, study design, or patient BMI did not significantly impact study results in a meta-regression model. The association was higher for cardiac surgery 2.03 (95% PI, 1.13-4.05) compared with surgeries of other types (P=.001). CONCLUSIONS These results support the consideration of diabetes as an independent risk factor for SSIs for multiple surgical procedure types. Continued efforts are needed to improve surgical outcomes for diabetic patients. Infect. Control Hosp. Epidemiol. 2015;37(1):88-99.
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            Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin.

            Elevation of glycosylated hemoglobin above levels of 11.5 mg.% has been considered a contraindication to penile prosthesis implantation in diabetic patients. We determine the predictive value of glycosylated hemoglobin A1C in penile prosthesis infections in diabetic and nondiabetic patients to confirm or deny this prevalent opinion. We conducted a 2-year prospective study of 389 patients, including 114 diabetics, who underwent 3-piece penile prosthesis implantation. All patients had similar preoperative preparation without regard to diabetic status, control or glycosylated hemoglobin A1C level. Risk of infection was statistically analyzed for diabetics versus nondiabetics, glycosylated hemoglobin A1C values above and below 11.5 mg.%, insulin dependent versus oral medication diabetics, and fasting blood sugars above and below 180 mg.%. Prosthesis infections developed in 10 diabetics (8.7%) and 11 nondiabetics (4.0%). No increased infection rate was observed in diabetics with high fasting sugars or diabetics on insulin. There was no statistically significant increased infection risk with increased levels of glycosylated hemoglobin A1C among all patients or among only the diabetics. In fact, there was no meaningful difference in the median or mean level of glycosylated hemoglobin A1C in the infected and noninfected patients regardless of diabetes. Use of glycosylated hemoglobin A1C values to identify and exclude surgical candidates with increased risk of infections is not proved by this study. Elevation of fasting sugar or insulin dependence also does not increase risk of infection in diabetics undergoing prosthesis implantation.
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              North American consensus document on infection of penile prostheses.

              To issue a consensus document on the prevention, management, and research of infection associated with penile prostheses, as neither professional associations nor governmental entities have issued guidelines that are specific to this infection.
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                Author and article information

                Journal
                Transl Androl Urol
                Transl Androl Urol
                TAU
                Translational Andrology and Urology
                AME Publishing Company
                2223-4691
                November 2017
                November 2017
                : 6
                : Suppl 5
                : S774-S775
                Affiliations
                [1 ]Department of Urology, Indiana University , Indianapolis, Indiana, USA;
                [2 ]Men’s Health Center , Indianapolis, Indiana, USA
                Author notes
                Correspondence to: Dr. Jason R. Kovac, MD, PhD, FACS, FRCSC. Men’s Health Center, 8240 Naab Road, Suite 220, Indianapolis, Indiana 46260, USA. Email: jkovac@ 123456urologyin.com .
                Article
                tau-06-S5-S774
                10.21037/tau.2017.11.14
                5715177
                6141819f-4eaf-41bb-9dc6-ec9a3edcdc8e
                2017 Translational Andrology and Urology. All rights reserved.
                History
                : 11 November 2017
                : 13 November 2017
                Categories
                Editorial

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