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

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. This retrospective single-center 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. 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. 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.