Year: 2020
Type: article
Study design: Observational Study
Abstract: Systems Pharmacists (ASHP) and the American Urologic Association (AUA) recommend administering a single high-dose of 5mg/kg (based on dosing weight) of gentamicin preoperatively, which differs from the conventional recommendation of administering a preoperative dose of 2mg/kg.Surgeons have been slow to adopt this change because of a presumed risk of nephrotoxicity, despite significant evidence that it is safe when used for therapeutic indications.However, no previous study has investigated the clinical implementation of this new guideline by urologists.We sought to determine the rate of preoperative gentamicin under-dosing in the urology patient and to delineate risk factors for under-dosing.METHODS: We retrospectively reviewed the anesthesia records of all adult patients (age > 18 years) who underwent urologic surgery at our tertiary care medical center from January 1, 2017 through October 3, 2019.RESULTS: Among a total of 1927 patients who received gentamicin preoperatively, the median gentamicin dose was 1.93 mg/kg (IQR 1.65 to 3.41).90% of patients received less than 4.5 mg/kg and 35% received less than 1.7mg/kg.Patients received a median of 2.6 mg/kg (IQR: -2.94 to -1.09) less than the recommended gentamicin dose, per ASHP and AUA guidelines.Patients over the age of 70 years were significantly more likely to be under-dosed with gentamicin preoperatively (OR 1.54, p<0.001).Patients who underwent endoscopic upper urinary tract surgery (OR 0.68, p[0.001) and those who underwent open or laparoscopic surgery (OR 0.33, p<0.001) were significantly less likely to be under-dosed than those who underwent endoscopic lower urinary tract surgery.CONCLUSIONS: Preoperative gentamicin is commonly underdosed for urologic procedures.At such low doses gentamicin is likely to lose its bactericidal properties.Older age (> 70 years) and endoscopic lower urinary tract surgery are significant risk factors for receiving a substantially lower than recommended dose.The risk of postoperative acute kidney injury following correct preoperative gentamicin dosing in urology patient and the risk of postoperative infection in those who are under-dosed has not yet been studied, however will be included in the future analyses of this dataset.
Source: The Journal of Urology
Authors: Ralph Grauer*, Jennifer Lobo, Ayca Erdoganb, Bjorn Bergc, Hyojung Kang, Matthew Clements, Stephen Culp, Tracey Krupski
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3020938294