Login to Access Video or Poster Abstract: MP25-15
Sources of Funding: University of Chicago Institute for Translational Medicine

Introduction

Prescribing oral antibiotics following IPP implantation is common practice; however, the impact of oral antibiotics on device infection and explantation is unknown. We sought to identify risk factors associated with device explantation in a prospective national database focusing on the role of outpatient oral antibiotics.

Methods

Using MarketScan, we identified men who underwent IPP placement from 2003-2014 and their associated clinical and demographic data. The primary endpoint was subsequent device explantation as determined by IPP removal CPT codes. Multivariate analysis assessed the effect of comorbidity and outpatient oral antibiotics on device explantation.

Results

10,847 men underwent IPP placement, with 228 (2.1%) undergoing subsequent explantation at a median of 42 days postoperatively (IQR 27-58). Postoperative oral antibiotics were prescribed following 6528 cases (60.6%). Patients with diabetes, higher Charlson comorbidity index (CCI) and history of prior IPP incurred higher rates of explantation, whereas rates did not differ in men receiving postoperative oral antibiotics (Table 1). On multivariate analysis, diabetes, CCI greater than 2 and prior IPP placement were all associated with increased odds of explantation (p<0.05). Postoperative oral antibiotics did not decrease the odds of explantation and trended towards harm (OR 1.27, 95% CI 0.96-1.68). Among the subset of patients with preoperative intravenous antibiotic data (3008), a regimen consistent with AUA guidelines was administered in 2006 (66.7%). Rate of explantation was lower in patients who received an AUA-recommended antibiotic regimen, although the difference was not significant (1.4 vs 2.3%, p=0.07). However, significantly lower explant rates were experienced by men receiving an aminoglycoside (1.4 vs 2.6%, p=0.04).

Conclusions

This review of a prospectively maintained national database did not demonstrate a benefit for postoperative oral antibiotics following IPP. Although this may be related to unmeasured risk factors prompting use of oral antibiotics, it suggests that routine use may be unnecessary and potentially detrimental. In contrast, perioperative intravenous aminoglycoside use is one modifiable factor that may reduce the risk of explantation.

Funding

University of Chicago Institute for Translational Medicine