title: Propensity-based study of aminoglycoside nephrotoxicity in patients with severe sepsis or septic shock.
abstract: To assess the risk of acute kidney injury (AKI) attributable to aminoglycosides (AGs) in patients with severe sepsis or septic shock, we performed a retrospective cohort study in one medical intensive care unit (ICU) in France. Patients admitted for severe sepsis/septic shock between November 2008 and January 2010 were eligible. A propensity score for AG administration was built using day 1 demographic and clinical characteristics. Patients still on the ICU on day 3 were included. Patients with renal failure before day 3 or endocarditis were excluded. The time window for assessment of renal risk was day 3 to day 15, defined according to the RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification. The AKI risk was assessed by means of a propensity-adjusted Cox proportional hazards regression analysis. Of 317 consecutive patients, 198 received AGs. The SAPS II (simplified acute physiology score II) score and nosocomial origin of infection favored the use of AGs, whereas a preexisting renal insufficiency and the neurological site of infection decreased the propensity for AG treatment. One hundred three patients with renal failure before day 3 were excluded. AGs were given once daily over 2.6 ± 1.1 days. AKI occurred in 16.3% of patients in a median time of 6 (interquartile range, 5 to 10) days. After adjustment to the clinical course and exposure to other nephrotoxic agents between day 1 and day 3, a propensity-adjusted Cox proportional hazards regression analysis showed no increased risk of AKI in patients receiving AGs (adjusted relative risk = 0.75 [0.32 to 1.76]). In conclusion, in critically septic patients presenting without early renal failure, aminoglycoside therapy for less than 3 days was not associated with an increased risk of AKI.
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
authors.forename: W
authors.initials: W
authors.lastname: Picard
authors.affiliation: INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, Université de Bordeaux, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Bazin
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
authors.forename: B
authors.initials: B
authors.lastname: Clouzeau
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
authors.forename: H-N
authors.initials: HN
authors.lastname: Bui
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
authors.forename: M
authors.initials: M
authors.lastname: Soulat
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
authors.forename: E
authors.initials: E
authors.lastname: Guilhon
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Vargas
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
authors.forename: G
authors.initials: G
authors.lastname: Hilbert
authors.affiliation: INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, Université de Bordeaux, Bordeaux, France Département de Pharmacotoxicologie, CHU de Bordeaux, Bordeaux, France.
authors.forename: S
authors.initials: S
authors.lastname: Bouchet
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
authors.forename: D
authors.initials: D
authors.lastname: Gruson
authors.affiliation: INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, Université de Bordeaux, Bordeaux, France Département de Pharmacotoxicologie, CHU de Bordeaux, Bordeaux, France.
authors.forename: N
authors.initials: N
authors.lastname: Moore
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, Université de Bordeaux, Bordeaux, France alexandre.boyer@chu-bordeaux.fr.
authors.forename: A
authors.initials: A
authors.lastname: Boyer
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D000328:Adult; D000368:Aged; D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents