0.05% Chlorhexidine gluconate is not associated with infection in antibiotic impregnated inflatable penile prosthesis surgery: results from a large multi-institutional collaborative.
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Ivan Samuel J, Abou Chawareb Elia, Hammad Muhammed, Lesgart Michael, Baird Bryce, Bajic Petar, Barham David W, Bernie Helen L, Bole Raevti, Chung Paul, Cowan Ketch, Dominick Zayda, Good Jacob, Helo Sevann, Hsieh Michael H, Im Brian H, Kadakia Yash, Kohler Tobias, Lentz Aaron C, Mass-Lindenbaum Marcelo, Morey Allen F, Nguyen Vi, Pereira Thairo, Perito Paul, Sadeghi-Nejad Hossein, Schammel Joshua, Shridharani Anand, Sarantos Nicklas, Suarez-Sarmiento Alfredo, Warner J Nicholas, Welliver Charles, Ziegelmann Matthew, Yafi Faysal A, Gross Martin S, Simhan Jay
Аннотация
AIM: Assess the relationship of 0.05% CHG and antibiotic impregnated IPP infection in a large multi-institutional cohort.
METHODS: We retrospectively reviewed a multi-institutional cohort of patients who underwent antibiotic impregnated IPP implantation. We identified cases using intraoperative 0.05% CHG and an equal number of consecutive control cases without 0.05% CHG use from each center for comparison. The primary outcome was IPP infection requiring explantation. Patient demographics and surgical variables were analyzed using chi-square tests and multivariable logistic regression to identify variables associated with infection.
OUTCOMES: The primary outcome was IPP infection requiring device explanation.
RESULTS: Among 14 participating institutions, 761 cases using an antibiotic impregnated IPP were analyzed. Of these, 348 (45.7%) had 0.05% CHG used during the case. Median follow-up was 4 months (interquartile range 1-12) for the 0.05% CHG group and 8 months (interquartile range 2-21) for the control group.Intraoperative 0.05% CHG utilization was not associated with antibiotic impregnated IPP infection rate (1.9% vs. 2.0%, P = .9). On multivariable analysis, prior IPP infection (OR 6.32, 95% CI 1.32-30.2, P = .021) and prior priapism (OR 10.01, 95% CI 1.18-89.7, P = .039) were associated with increased infection risk.
CLINICAL IMPLICATIONS: The use of 0.05% CHG irrigation with antibiotic impregnated IPPs was associated with similar infection rates compared to antibiotic irrigation.
STRENGTHS AND LIMITATIONS: Limitations include the use of a historical comparator cohort which may introduce unknown confounders, practice variation between multiple sites, shorter follow-up in the 0.05% CHG cohort, and the low incidence of IPP infection which may limit statistical power despite a large sample. The major strengths include the large, multi-institutional cohort, and the use of consecutive patients to minimize selection bias.
CONCLUSION: 0.05% CHG utilization was not associated with infection rates in antibiotic impregnated IPPs.