Incidence and Risk Factors for Perioperative Infections After Robot-Assisted Radical Prostatectomy: A Multicenter Study

Objectives: To evaluate the incidence, antimicrobial prophylaxis patterns, and risk factors for perioperative infections after robot-assisted radical prostatectomy (RARP) in a large Japanese multicenter cohort. Methods: We retrospectively analyzed 6660 patients who underwent RARP between 2009 and 2021 and received Japanese Urological Association guideline-recommended prophylaxis with cefazolin (CEZ), ampicillin/sulbactam (ABPC/SBT), or second-generation cephalosporins (2ndCPs). Surgical site infection (SSI), urinary tract infection (UTI), and remote infection (RI) within 30 postoperative days were assessed. Infection rates were compared according to antibiotic regimen and duration (≤ 24 vs. > 24 h), and risk factors were evaluated using logistic regression. Results: CEZ, ABPC/SBT, and 2ndCPs were administered to 4321 (64.9%), 1501 (22.7%), and 838 (12.6%) patients, respectively. Overall incidences of SSI, UTI, and RI were 1.2%, 1.4%, and 0.3%, respectively. SSI was mainly superficial, whereas deep or organ/space SSI was rare. No significant differences in SSI incidence were observed between ≤ 24- and > 24-h administration within each regimen. Multivariate analysis identified bowel injury as an independent risk factor for SSI. For UTI, body mass index (BMI) ≥ 30 kg/m², leakage at catheter removal, indwelling catheterization ≥ 8 days, and ABPC/SBT use were associated factors. Conclusions: Perioperative infection rates after RARP were low. Prophylaxis within 24 h, particularly with CEZ or 2ndCPs, may be sufficient. Prevention of bowel injury and appropriate catheter management may further reduce postoperative infections.