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

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Urologia Internationalis Pub Date : 2025-08-26 DOI:10.1159/000548188

Michael Glietsch, Simon Blaschke, Anke Lux, Gernot Geginat, Martin Schostak

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Abstract

Introduction: Aminoglycosides, valued for their lower antimicrobial resistance, are used for perioperative antibiotic prophylaxis (PAP) in urological procedures such as robot-assisted radical prostatectomy (RARP). However, data regarding the safety of gentamicin in robot-assisted surgery remain limited. This study assessed the incidence of acute kidney injury (AKI) associated with PAP with single-dose gentamicin during the transition from open prostatectomy to RARP.

Methods: This single-center, retrospective, matched case-control study included 77 RARP patients receiving gentamicin and 72 matched controls receiving cefuroxime. AKI was assessed using the Kidney Disease: Improving Global Outcome (KDIGO) criteria, considering age, comorbidities, and prostate weight.

Results: AKI occurred in 33.8% of the gentamicin group versus 9.7% of the cefuroxime group, resulting in an odd's ratio (OR) of 6.25. In the gentamicin group, grade 1 AKI was most frequent (19.5%), followed by grade 2 (7.8%) and grade 3 (6.5%). In the cefuroxime group, grades 1 (5.6%) and 2 (4.2%) were observed. Prostate volume and gentamicin use emerged as independent cofactors. Limitations include missing long-term data, variable gland measurements, and inclusion of patients with pre-existing kidney disease.

Conclusion: The risk of AKI was significantly higher after PAP with gentamicin compared to PAP with cefuroxime (OR: 6.25, 95% CI: 2.095-18.664, p = 0.001), suggesting that PAP with gentamicin should be avoided in RARP.

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机器人辅助前列腺切除术围手术期庆大霉素预防增加急性肾损伤风险。

氨基糖苷因其较低的抗菌素耐药性而受到重视，被用于泌尿外科手术的围手术期抗生素预防（PAP），如机器人辅助根治性前列腺切除术（RARP）。然而，关于庆大霉素在机器人辅助手术中的安全性的数据仍然有限。本研究评估了从开放式前列腺切除术到RARP过渡期间，单剂量庆大霉素PAP相关的急性肾损伤（AKI）发生率。方法：回顾性单中心匹配病例对照研究，纳入77例RARP患者接受庆大霉素治疗，72例匹配对照组接受头孢呋辛治疗。AKI的评估采用肾脏疾病：改善总体预后（KDIGO）标准，考虑年龄、合并症和前列腺重量。结果：庆大霉素组发生AKI的比例为33.8%，头孢呋辛组为9.7%,Odd’s ratio （OR）为6.25。庆大霉素组1级AKI发生率最高（19.5%），其次是2级（7.8%）和3级（6.5%）。头孢呋辛组为1级（5.6%）和2级（4.2%）。前列腺体积和庆大霉素的使用成为独立的辅助因素。局限性包括缺少长期数据，可变的腺体测量，以及纳入已有肾脏疾病的患者。结论：庆大霉素联合PAP与头孢呋辛联合PAP发生AKI的风险显著高于头孢呋辛联合PAP (OR: 6.25, 95% CI: 2.095 ~ 18.664, p = 0.001)，提示RARP患者应避免使用庆大霉素联合PAP。

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来源期刊

Urologia Internationalis 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

6.20%

发文量

审稿时长

3-8 weeks

期刊介绍： Concise but fully substantiated international reports of clinically oriented research into science and current management of urogenital disorders form the nucleus of original as well as basic research papers. These are supplemented by up-to-date reviews by international experts on the state-of-the-art of key topics of clinical urological practice. Essential topics receiving regular coverage include the introduction of new techniques and instrumentation as well as the evaluation of new functional tests and diagnostic methods. Special attention is given to advances in surgical techniques and clinical oncology. The regular publication of selected case reports represents the great variation in urological disease and illustrates treatment solutions in singular cases.