(543) Antibiotic Prophylaxis for Artificial Urinary Sphincter Surgery - Trends in AUA Best Practices Guideline Adherence
Authors: Callegari M , Rhodes S , Brant A , Sun H , Jesse E , Prunty M , Shoag J , Scarberry K , Gupta S 
Published: May 2023

Abstract

Introduction
Infections involving an artificial urinary sphincter (AUS) can be devastating and costly. Antibiotic use during implantation is a mainstay in preserving the implant as well as reducing morbidity for patients. While antibiotic guidelines regarding urologic procedures have been published, it remains unclear how widespread these recommendations adoption or use is in practice especially with regards to AUS implantation.

Objective
Using the premier healthcare database (PHD), a large national database, we assessed trends in antibiotic prophylaxis for AUS in conjunction with the AUA Best Practice Guidelines on urologic procedures and antimicrobial prophylaxis.

Methods
The premier healthcare database (PHD) was queried from Q1 of year 2000 to Q1 of 2020. Encounters involving AUS insertion, removal, and/or associated complications were identified via ICD diagnosis, ICD procedure, and CPT codes. Premier charge codes were used to identify antibiotics administered during the insertion encounter. Antibiotics were grouped into categories based on antibiotic classification. Information pertaining to the day a particular item was billed was used to identify whether administration was ‘guidelines based’ or not. Antibiotic administration was considered guidelines based if they consisted of either Aminoglycosides and 1st/2nd generation Cephalosporin or Monobactam (Aztreonam) and 1st/2nd generation Cephalosporin. Removal or complications associated with AUS were identified on subsequent encounters and linked via the patients’ hospital identifier. Differences in removal and complication rates between patients with guidelines-based antibiotic administration at insertion were assessed via chi-squared tests. The association of guidelines-based administration with other categorical variables was also assessed via chi-squared tests. Differences between groups in continuous variables were assessed via Mann-Whitney U tests.

Results
A total of 9,976 patients having undergone AUS surgery were identified between 2000 and 2020, of which 1548 (16%) received AUA-adherent antibiotics. Six thousand six hundred and twenty six (66%) encounters were isolated since 2011. Mean age was 69.8 with 7485 (75%) Caucasian, 7158 (71%) utilizing Medicare. Mean length of hospital stay (LOS) was 0.4 days overall and 0.2 days compared to 0.5 (p&lt;0.001) for patients receiving AUA-adherent to AUA non-adherent antibiotics. Patients receiving AUA-adherent antibiotic regimens (359 [23%]) had fewer complications than those receiving non-adherent regimens (2335 [28%]) (p&lt;0.001) however no statistically significant reduction in encounters for removal or repair were noted (AUA-adherent 307 [20%]) to AUA-non-adherent 1826 [22%]) (p=0.11). No statistical significance was noted with regards to the decade of encounter, age, or race of the patient, or if the patient had received AUS teaching. Only 4.95% of patients received antibiotic therapy beyond the recommended 24-hour prophylactic recommendations.

Conclusions
Adherence to AUA-recommended, best practice antimicrobial guidlines, with regards to AUS implantation appears low. This is likely multifactorial and dependent on individual surgeon preferences, local antibiograms and resistance patterns as well as individual patient sensitivities and tolerances.

Disclosure
No