title: Risk of AKI with gentamicin as surgical prophylaxis.
abstract: In 2009, the Scottish government issued a target to reduce Clostridium difficile infection by 30% in 2 years. Consequently, Scottish hospitals changed from cephalosporins to gentamicin for surgical antibiotic prophylaxis. This study examined rates of postoperative AKI before and after this policy change. The study population comprised 12,482 adults undergoing surgery (orthopedic, urology, vascular, gastrointestinal, and gynecology) with antibiotic prophylaxis between October 1, 2006, and September 30, 2010 in the Tayside region of Scotland. Postoperative AKI was defined by the Kidney Disease Improving Global Outcomes criteria. The study design was an interrupted time series with segmented regression analysis. In orthopedic patients, change in policy from cefuroxime to flucloxacillin (two doses of 1 g) and single-dose gentamicin (4 mg/kg) was associated with a 94% increase in AKI (P=0.04; 95% confidence interval, 93.8% to 94.3%). Most patients who developed AKI after prophylactic gentamicin had stage 1 AKI, but some patients developed persistent stage 2 or stage 3 AKI. The antibiotic policy change was not associated with a significant increase in AKI in the other groups. Regardless of antibiotic regimen, however, rates of AKI were high (24%) after vascular surgery, and increased steadily after gastrointestinal surgery. Rates could only be ascertained in 52% of urology patients and 47% of gynecology patients because of a lack of creatinine testing. These results suggest that gentamicin should be avoided in orthopedic patients in the perioperative period. Our findings also raise concerns about the increasing prevalence of postoperative AKI and failures to consistently measure postoperative renal function.
authors.affiliation: Renal Unit, Ninewells Hospital, National Health Service Tayside, Dundee, United Kingdom; Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, United Kingdom; samira.bell@nhs.net.
authors.forename: Samira
authors.initials: S
authors.lastname: Bell
authors.affiliation: Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, United Kingdom;
authors.forename: Peter
authors.initials: P
authors.lastname: Davey
authors.affiliation: Scottish Antimicrobial Prescribing Group, Scottish Medicines Consortium, Glasgow, United Kingdom;
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
authors.affiliation: Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, United Kingdom;
authors.forename: Charis
authors.initials: C
authors.lastname: Marwick
authors.affiliation: Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, United Kingdom;
authors.forename: Thenmalar
authors.initials: T
authors.lastname: Vadiveloo
authors.affiliation: Scottish Antimicrobial Prescribing Group, Scottish Medicines Consortium, Glasgow, United Kingdom;
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Sneddon
authors.affiliation: Scottish Antimicrobial Prescribing Group, Scottish Medicines Consortium, Glasgow, United Kingdom;
authors.forename: Andrea
authors.initials: A
authors.lastname: Patton
authors.affiliation: Public Health and Intelligence, National Services Scotland/Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom; and.
authors.forename: Marion
authors.initials: M
authors.lastname: Bennie
authors.affiliation: Division of Cancer Research, Department of Pathology, University of Dundee, Dundee, United Kingdom.
authors.forename: Stewart
authors.initials: S
authors.lastname: Fleming
authors.affiliation: Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, United Kingdom;
authors.forename: Peter T
authors.initials: PT
authors.lastname: Donnan
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000187:drug effects*; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005839:Gentamicins / Q000009:adverse effects*; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D012307:Risk Factors; D012606:Scotland; D013520:Urologic Surgical Procedures / Q000706:statistics & numerical data; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins