title: Gentamicin-associated acute kidney injury.
abstract: BACKGROUND
  The incidence of gentamicin-associated acute kidney injury (AKI) as defined by the RIFLE criteria is unknown.
  
  
  OBJECTIVE
  We performed a retrospective observational study to examine this and the predictive value of RIFLE stage on patient outcome in this setting.
  
  
  METHODS
  We included all patients who were treated with gentamicin at our centre over a 1-month period. Data on 228 patients across all specialities were collected by manual searching of hospital notes and electronic pathology reporting systems. Information collected included baseline and peak serum creatinine results, gentamicin dose and serum levels, the presence of additional renal insults and the Stoke co-morbidity index.
  
  
  RESULTS
  AKI occurred in 51 (24.4%) patients; 37 (17.7%) 'Risk', 9 (4.3%) 'Injury', 5 (2.4%) 'Failure'. Independent predictors of gentamicin associated AKI were number of gentamicin levels >2 mg/l (OR 1.845, 95% CI 1.22 to 2.79) and higher baseline serum creatinine (OR 1.014, 95% CI 1.001-1.028). There was a greatly increased risk of in-hospital mortality in the AKI group as compared to those without AKI (45.1% vs. 19.1%, OR 3.48, 95% CI 1.8-6.9, P = 0.0004). Risk of in hospital mortality increased with each RIFLE stage (P < 0.0001).
  
  
  CONCLUSIONS
  This study shows that gentamicin-associated AKI remains a common and potentially serious clinical problem. There is a strong correlation between RIFLE class and in-hospital mortality.
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Selby
authors.forename: Susan
authors.initials: S
authors.lastname: Shaw
authors.forename: Nicholas
authors.initials: N
authors.lastname: Woodier
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Fluck
authors.forename: Nitin V
authors.initials: NV
authors.lastname: Kolhe
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D005839:Gentamicins / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins