Perioperative Gentamicin Prophylaxis in Robot-Assisted Prostatectomy Increases Acute Kidney Injury Risk.

Area of Science:

• Urology
• Nephrology
• Surgical Oncology

Background:

• Aminoglycosides like gentamicin are used for perioperative antibiotic prophylaxis (PAP) in urological procedures.
• Robot-assisted radical prostatectomy (RARP) is increasingly common, but safety data for gentamicin in this setting is limited.
• This study investigates acute kidney injury (AKI) incidence with gentamicin PAP during the RARP transition.

Purpose of the Study:

• To assess the incidence of AKI associated with single-dose gentamicin PAP in RARP patients.
• To compare AKI rates between gentamicin and cefuroxime PAP in RARP.
• To identify risk factors for AKI in RARP patients receiving gentamicin.

Main Methods:

• Retrospective, single-center, matched case-control study.
• 77 RARP patients receiving gentamicin PAP were matched with 72 controls receiving cefuroxime PAP.
• AKI assessed using KDIGO criteria, considering age, comorbidities, and prostate weight.

Main Results:

• AKI occurred in 33.8% of the gentamicin group versus 9.7% in the cefuroxime group (OR: 6.25).
• Higher AKI rates in the gentamicin group included Grade 1 (19.5%), Grade 2 (7.8%), and Grade 3 (6.5%).
• Prostate volume and gentamicin use were independent risk factors for AKI.

Conclusions:

• PAP with gentamicin is associated with a significantly higher risk of AKI in RARP compared to cefuroxime.
• Gentamicin PAP should be avoided in RARP procedures due to increased AKI risk.
• Further research needed on long-term outcomes and alternative prophylaxis strategies.