MP83-16 PREOPERATIVE GENTAMICIN UNDERDOSING IN THE UROLOGY PATIENT

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety IV (MP83)1 Apr 2020MP83-16 PREOPERATIVE GENTAMICIN UNDERDOSING IN THE UROLOGY PATIENT Jane Kurtzman*, Ezra Margolin, Gen Li, Justin Aaron, Christine Kubin, and Christopher Anderson Jane Kurtzman*Jane Kurtzman* More articles by this author , Ezra MargolinEzra Margolin More articles by this author , Gen LiGen Li More articles by this author , Justin AaronJustin Aaron More articles by this author , Christine KubinChristine Kubin More articles by this author , and Christopher AndersonChristopher Anderson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000975.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gentamicin is an aminoglycoside antibiotic commonly used for antimicrobial prophylaxis in urologic procedures. As of 2013, both the American Society of Health-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 under-dosed 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 of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1261-e1262 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman* More articles by this author Ezra Margolin More articles by this author Gen Li More articles by this author Justin Aaron More articles by this author Christine Kubin More articles by this author Christopher Anderson More articles by this author Expand All Advertisement PDF downloadLoading ...