title: Risk factors for aminoglycoside-associated nephrotoxicity in surgical intensive care unit patients.
abstract: BACKGROUND
  Aminoglycosides are commonly used antibiotics in the intensive care unit (ICU), but are associated with nephrotoxicity. This study evaluated the development of aminoglycoside-associated nephrotoxicity (AAN) in a single surgical intensive care unit.
  
  
  METHODS
  Adult patients in our surgical ICU who received more than two doses of aminoglycosides were retrospectively reviewed for demographics, serum creatinine, receipt of nephrotoxins [angiotensin converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers, diuretics, non-steroidal anti-inflammatory drugs, cyclosporine, tacrolimus, vasopressors, vancomycin and intravenous iodinated contrast] and the need for dialysis. AAN was defined as an increase in serum creatinine >0.5 mg/dL on at least 2 consecutive days. Univariate and multiple regression analyses were performed.
  
  
  RESULTS
  Sixty-one patients (43 males) receiving aminoglycoside were evaluated. Mean age, weight, initial serum creatinine, and duration of aminoglycoside therapy were 58.7 (±15) years, 83.3 (±24.4) kg, 0.9 (±0.5) mg/dL, and 4 (±2.3) days, respectively. Thirty-one (51%) aminoglycoside recipients also received additional nephrotoxins. Seven aminoglycoside recipients (11.5%) developed AAN, four of whom required dialysis and all had received additional nephrotoxins. Only concurrent use of vasopressors (P = 0.041) and vancomycin (P = 0.002) were statistically associated with AAN. Receipt of vasopressors or vancomycin were independent predictors of acute kidney insufficiency (AKI) with odds ratios of 19.9 (95% CI: 1.6-245, P = 0.019) and 49.8 (95% CI: 4.1-602, P = 0.002), respectively. Four patients (6.6%) required dialysis.
  
  
  CONCLUSIONS
  In critically ill surgical patients receiving aminoglycosides, AAN occurred in 11.5% of the patients. Concurrent use of aminoglycosides with other nephrotoxins increased the risk of AAN.
authors.affiliation: Department of Pharmacy and Center of Critical Care, The Ohio State University Medical Center, Room 368, Doan Hall, 410 West Tenth Avenue, Columbus, OH 43210, USA.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Gerlach
authors.forename: Stanislaw P
authors.initials: SP
authors.lastname: Stawicki
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
authors.forename: Claire
authors.initials: C
authors.lastname: Murphy
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