The association of aminoglycoside plasma levels with mortality in patients with gram-negative bacteremia.
To determine the association of aminoglycoside levels with mortality from gram-negative bacteremia, we analyzed the case reports of patients from four prospective, randomized, and controlled clinical trials of gentamicin, tobramycin, and amikacin. Twelve (13.5%) of 89 patients died. One (2.4%) death occurred in 41 patients with early (1-hr postinfusion) peak concentrations of greater than 5 micrograms/ml of gentamicin and tobramycin and of greater than 20 micrograms of amikacin/ml; nine deaths (20.9%) occurred in 43 patients with lower concentrations. Five (8.3%) deaths occurred in 60 patients with mean peak concentrations for the entire course of therapy of greater than 5 micrograms/ml of gentamicin and tobramycin and of greater than 20 micrograms of amikacin/ml; five (20.8%) deaths occurred in 24 patients with lower concentrations. Stepwise discriminant analysis showed that therapeutic early peak concentration was a significant factor in the presence of three other factors: severity of underlying illness, peak temperature, and initial leukocyte count. The results suggest the importance of achieving adequate early aminoglycoside levels in patients with gram-negative bacteremia.
D000328:Adult; D000368:Aged; D000583:Amikacin / Q000009:adverse effects / Q000097:blood*; D001831:Body Temperature; D005839:Gentamicins / Q000009:adverse effects / Q000097:blood*; D006090:Gram-Negative Bacteria; D006801:Humans; D007612:Kanamycin / Q000031:analogs & derivatives*; D007674:Kidney Diseases / Q000139:chemically induced; D007958:Leukocyte Count; D008875:Middle Aged; D011512:Proteus Infections / Q000401:mortality; D018805:Sepsis / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D013223:Statistics as Topic; D014031:Tobramycin / Q000009:adverse effects / Q000097:blood*
D005839:Gentamicins; D007612:Kanamycin; D000583:Amikacin; D014031:Tobramycin