Department of Urology, Columbia University Irving Medical Center, New York, NY.
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.
Urology. 2021 Jul;153:164-168. doi: 10.1016/j.urology.2021.01.037. Epub 2021 Jan 29.
To determine the rate of and predictors for guideline-discordant preoperative gentamicin dosing in urologic surgery and to assess the risk of nephrotoxicity in patients who receive the recommended high-dose prophylaxis.
We retrospectively reviewed all adult patients who received preoperative gentamicin for urologic surgery from January 1, 2017 - October 3, 2019. Doses were categorized as guideline-concordant or -discordant using a cutoff of 4.5 mg/kg dosing weight. We used multivariable logistic regression to identify predictors for guideline-discordant dosing. Postoperative kidney injury was assessed using RIFLE criteria.
Among 2134 patients, 89% received a preoperative dose ≤ 4.5 mg/kg. Older age (70+ years) and endoscopic surgery were significant risk factors for guideline-discordant dosing (OR 2.54, P< 0.001; OR 6.21, P<0.001). Among 735 patients with complete data, there was no significant difference in the risk of kidney injury between those who received a dose less than 4.5 mg/kg and those who received a higher dose (OR 0.89, 95% CI: 0.26 - 2.99, P = 0.75).
Preoperative gentamicin is commonly administered at lower than recommended doses for urologic surgery. Older age and endoscopic surgery are significant predictors of guideline-discordant dosing. The risk of kidney injury following high-dose preoperative gentamicin for urologic procedures is likely comparable to the risk at lower doses.
确定泌尿外科手术中术前庆大霉素剂量与指南不符的发生率和预测因素，并评估接受推荐高剂量预防方案的患者发生肾毒性的风险。
我们回顾性分析了 2017 年 1 月 1 日至 2019 年 10 月 3 日期间接受术前庆大霉素治疗的所有成年泌尿外科手术患者。根据 4.5mg/kg 给药体重的截值，将剂量分为与指南一致或不一致。我们使用多变量逻辑回归来确定与指南不符的剂量的预测因素。使用 RIFLE 标准评估术后肾损伤。
在 2134 例患者中，89%接受的术前剂量≤4.5mg/kg。年龄较大（≥70 岁）和内镜手术是与指南不符的剂量的显著危险因素（OR 2.54，P<0.001；OR 6.21，P<0.001）。在 735 例有完整数据的患者中，接受剂量低于 4.5mg/kg 和接受更高剂量的患者之间肾损伤的风险无显著差异（OR 0.89，95%CI：0.26-2.99，P=0.75）。
泌尿外科手术中术前庆大霉素通常低于推荐剂量给药。年龄较大和内镜手术是与指南不符的剂量的显著预测因素。接受高剂量术前庆大霉素预防泌尿外科手术的肾损伤风险可能与低剂量时相当。
