title: Outcomes in patients with gram-negative sepsis treated with gentamicin.
abstract: OBJECTIVE
  Recent changes to therapeutic drug monitoring (TDM) of gentamicin have been advocated in Australia. It remains uncertain whether these will have an effect on hard clinical endpoints. The aim of this study was to determine clinical outcomes in patients with gram-negative infections treated with gentamicin.
  
  
  METHODS
  Microbiology results of patients with confirmed gram-negative cultures were retrospectively reviewed and those treated with gentamicin included. Medical records were reviewed and patient demographics, diagnosis, renal function, comorbidities, gentamicin doses, duration, monitoring, concomitant antibiotics, antimicrobial sensitivity and clinical and microbiological outcomes recorded.
  
  
  RESULTS
  A total of 100 patients were included in the study: 52% were male, median age 64 years (17-97). Total body weight was recorded in 56% (median 74.5 kg, range 35-134 kg). Most patients had two or more important comorbidities. A total of 72% received empiric and 28% directed treatment. The organism was identified on blood culture in 45%, urine culture in 43% and aspiration of liver abscess in 12%; 95% of organisms were sensitive to gentamicin. Baseline renal function was normal in 62%. Mean gentamicin dose was 3.9 ± 0.9 mg/kg and mean duration 2.9 ± 2.5 days. Only 21% had optimal TDM. Clinical outcome was favourable in 90%. There were no cases of preventable serious toxicity.
  
  
  CONCLUSIONS
  Despite the modest doses of gentamicin used in an elderly population with comorbidities, as well as the absence of optimal TDM, outcomes were favourable without preventable serious toxicity.
authors.affiliation: Department of Clinical Pharmacology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, QLD, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Pillans
authors.affiliation: Royal Brisbane Hospital, Brisbane, Queensland, Australia.
authors.forename: Joel
authors.initials: J
authors.lastname: Iedema
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Donovan
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Newbery
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Venetia
authors.initials: V
authors.lastname: Whitehead
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Cameron
authors.initials: C
authors.lastname: Halliday
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Sheehy
authors.affiliation: University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Annaka
authors.initials: A
authors.lastname: Springford
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Tina
authors.initials: T
authors.lastname: Patterson
keywords: gentamicin; outcomes; therapeutic drug monitoring
references.citation: Ann Pharmacother. 1997 Dec;31(12):1514-8
references.pmid: 9416390
references.citation: Am J Med. 2003 Feb 15;114(3):194-8
references.pmid: 12637133
references.citation: Chemotherapy. 1997 Nov-Dec;43(6):442-50
references.pmid: 9395859
references.citation: Ther Drug Monit. 1990 Sep;12(5):427-33
references.pmid: 2127325
references.citation: Br J Clin Pharmacol. 2001;52 Suppl 1:35S-43S
references.pmid: 11564051
references.citation: Ann Intern Med. 1996 Apr 15;124(8):717-25
references.pmid: 8633831
references.citation: Ther Drug Monit. 1987 Sep;9(3):306-10
references.pmid: 3672575
references.citation: Br J Clin Pharmacol. 1995 Jun;39(6):597-603
references.pmid: 7654476
references.citation: Intern Med J. 2011 Jun;41(6):441-9
references.pmid: 21309997
references.citation: Pharmacoeconomics. 1998 Oct;14(4):385-94
references.pmid: 10344906
references.citation: Am J Med. 2003 Feb 15;114(3):239-40
references.pmid: 12637142
references.citation: Pathology. 1998 Aug;30(3):289-94
references.pmid: 9770195
references.citation: Antimicrob Agents Chemother. 1995 Mar;39(3):650-5
references.pmid: 7793867
references.citation: Pharmacotherapy. 2001 Apr;21(4):443-51
references.pmid: 11310518
references.citation: Ther Drug Monit. 2008 Dec;30(6):674-81
references.pmid: 19057371
references.citation: Ther Drug Monit. 1999 Feb;21(1):63-73
references.pmid: 10051056
references.citation: Intensive Care Med. 2002 Jul;28(7):936-42
references.pmid: 12122533
references.citation: Intern Med J. 2006 Jan;36(1):37-42
references.pmid: 16409311