Gentamicin Prophylaxis During Robot-assisted Radical Prostatectomy Causes Acute Kidney Injury: A Case-Control Study

Abstract Purpose Aminoglycosides, known for lower susceptibility to antimicrobial resistance (AMR), are commonly used for perioperative antibiotic prophylaxis (PAP) in urological procedures, including robot-assisted radical prostatectomy (RARP). However, limited data exist on their safety in RARP. Our study aimed to investigate the incidence of acute kidney injury (AKI) associated with gentamicin PAP in RARP patients during the transition from open prostatectomy to RARP. Methods We conducted a retrospective single-center matched case-control study involving 77 RARP patients receiving gentamicin and 72 matched controls receiving cefuroxime. AKI was evaluated using Kidney Disease: Improving Global Outcome (KDIGO) criteria, considering factors like age, comorbidities, and prostatic weight. Results In the gentamicin group, 26 patients developed AKI post-surgery (33.8%). Conversely, only seven AKI cases (9.7%) were identified in the cefuroxime group, resulting in an Odds Ratio (OR) of 6.25, indicating a significantly higher relative risk of AKI in the gentamicin group. AKI grade 1 was most common in the gentamicin group (19.5%), with some patients experiencing more severe AKI (grade 2: 7.8%, grade 3: 6.5%). In the cefuroxime group grades 1 (5.6%) and 2 (4.2%) AKI were observed. Prostate volume, along with gentamicin use, emerged as independent cofactors. The limitations include lack of long-term outcome data and inconsistent preoperative gland measurements. Cases with pre-existing kidney disease weren't excluded due to low power. Conclusions The incidence of AKI was significantly higher after PAP with gentamicin compared to cefuroxime (OR: 6.253, 95% CI: 2.095–18.664, p = 0.001), suggesting that gentamicin should be avoided for PAP in RARP procedures.