title: Low-dose Gentamicin for Uncomplicated Enterococcus faecalis Bacteremia May be Nephrotoxic in Children.
abstract: BACKGROUND
  Uncertainty exists regarding the role of synergistic gentamicin for uncomplicated Enterococcus faecalis bacteremia in children.
  
  
  METHODS
  We conducted a retrospective, observational study comparing clinical outcomes of children with E. faecalis bacteremia without endocarditis receiving ampicillin monotherapy with those receiving ampicillin along with low-dose gentamicin therapy. To account for nonrandom assignment of combination therapy, propensity score weighting was combined with multivariable regression to estimate the effect of combination therapy on duration of bacteremia, bacteremic relapse, and acute kidney injury (AKI).
  
  
  RESULTS
  One hundred sixty-three (52%) patients received ampicillin with low-dose gentamicin, and 150 (48%) patients received ampicillin monotherapy. Incorporating propensity-score weighting with additional adjustment for source control measures, patients receiving combination therapy experienced bacterial clearance 10 hours faster than children receiving ampicillin monotherapy (adjusted mean difference 0.42; confidence interval (CI), .02 to .82; P = .04). Bacteremic relapse was similar between the two groups (17% vs 18%); adjusted hazards ratio (aHR) 1.12; 95% CI, .65 to 1.92. Children receiving low-dose gentamicin had approximately twice the risk of developing AKI compared to children not receiving this agent, adjusting for the receipt of additional nephrotoxins (aHR 1.94; 95% CI, 1.48-2.97).
  
  
  CONCLUSIONS
  Our study suggests that for children with uncomplicated E. faecalis bacteremia, the addition of low-dose gentamicin may decrease the time to bacterial clearance by 10 hours but without any impact on recurrent bacteremia. However, with this potential benefit comes the increased likelihood of AKI. Low-dose gentamicin for the treatment of uncomplicated enterococcal bacteremia may pose harm to children with limited benefit.
authors.affiliation: Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina.
authors.forename: Sarai Little
authors.initials: SL
authors.lastname: Ibrahim
authors.affiliation: Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health.
authors.forename: Long
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, The Johns Hopkins University School of Medicine.
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Brady
authors.affiliation: Department of Pharmacy, Division of Pediatric Pharmacy, The Johns Hopkins Hospital.
authors.forename: Alice J
authors.initials: AJ
authors.lastname: Hsu
authors.affiliation: Department of Medicine, Division of Infectious Diseases.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Pranita D
authors.initials: PD
authors.lastname: Tamma
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D015142:Baltimore / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D013293:Enterococcus faecalis; D005839:Gentamicins / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D012306:Risk
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins
keywords: Enterococcus faecalis; aminoglycosides; gentamicin; pediatrics; synergy