An audit to look at dosing of prophylactic gentamicin and renal function in urology patients

Abstract

Background: At Glasgow royal infirmary (GRI), gentamicin is one of the antibiotics of choice for surgical prophylaxis in urology patients. Current GGC (Greater Glasgow and Clyde) guideline for prophylactic gentamicin dose recommend a height-based gentamicin dose and approximates to 3mg /Kg ideal body weight. GRI urology surgeons concerns of an increased incidence of patients getting post-operative infections. Other guidelines recommend using higher dose 5mg/kg gentamicin dose for prophylaxis. The purpose of this audit to assess the practice of gentamicin before the updating guideline will release. Methods: Adult patients in urology at GRI who had elective surgery given a prophylactic dose of gentamicin were included. The portal system was used to identify each patient who had gentamicin looking at operation note. Results: Out of 247 patients Included in this audit, 176 patients received a prophylactic dose of gentamicin approximating 3mg/kg. 77% (n=136) of all patients received the correct gentamicin dose as per guideline. 71 patients received a higher dose of gentamicin (mean 5.4 mg/kg). A significant rise in creatinine levels was observed in both dose regimens 3mg/kg and higher dose 5mg/kg. There was no significant difference in creatinine levels between the two dosage regimens 3mg/kg and 5mg/kg (p=0.10). Conclusion: This audit has shown there is a gap between the guideline and what is being practiced by surgeons. Further work is required to improve their awareness and become up to date with the guidelines.