Association between prophylactic antibiotics and post-ablation infections in renal cell carcinoma patients: a...

The role of prophylactic antibiotics in preventing infections following renal cell carcinoma (RCC) ablation remains unclear. We aimed to clarify whether prophylactic antibiotics reduce infection rates after RCC ablation and to identify patient subgroups who might benefit.

This retrospective, multicenter cohort study included T1a RCC patients who underwent percutaneous thermal ablation between April 2006 and May 2024, classified into prophylactic antibiotic (PA) and non-prophylactic antibiotic (nPA) groups. The primary outcome was infection, categorized as severe or non-severe, while secondary outcomes included duration of hospitalization, costs, fever, and acute kidney injury (AKI). Inverse Probability of Treatment Weighting (IPTW) and Overlap Weighting (OW) were employed to control for baseline differences, and the Firth's penalized likelihood method was applied to all logistic regression analyses.

A total of 895 patients (mean age 62.6 ± 13.5 years; 224 women) from five centers were included. Comparing the PA and nPA groups, the PA group showed lower overall infection rates than the nPA group (1.8% vs. 3.7%, P < 0.05 after IPTW and OW adjustments), but the rate of severe infections was only 0.4% and 1.1%, respectively (P = 0.14 after IPTW and P = 0.13 after OW adjustments). The PA group had longer hospital stays (5.1 ± 2.8 vs. 3.4 ± 1.9 days), higher costs (median 4,425 vs. 3,712 USD), and a higher incidence of AKI (10.1% vs. 5.5%) compared to the nPA group (all P < 0.05). Interaction and subgroup analyses revealed that diabetic patients with tumors of 3-4 cm in diameter had lower non-severe infection rates in the PA group compared to the nPA group (Adjusted OR = 0.07, 95% CI: 0.004-0.65, P for interaction = 0.02).

Routine prophylactic antibiotic use is not necessary in percutaneous renal cell carcinoma ablation; however, it may be considered for selected diabetic patients.