title: No increased risk of acute kidney injury after a single dose of gentamicin in patients with sepsis.
abstract: Background Aminoglycosides are frequently used in the empirical treatment of sepsis. However, aminoglycosides may induce acute kidney injury (AKI). Data is lacking on the renal safety of a single dose of aminoglycosides in septic patients visiting the emergency department (ED). Aim To investigate the incidence of AKI in septic patients after a single dose of gentamicin (5 mg/kg) and to evaluate possible risk factors. Methods This study retrospectively followed patients, aged ≥ 18 years, visiting the ED and fulfilling sepsis criteria for 1 year. Two groups were analysed: septic patients receiving gentamicin in combination with beta-lactam antibiotics and a control group with pneumosepsis patients only without gentamicin. Renal function was determined prior to admission, at presentation and during the following 2 weeks. AKI was defined according to the RIFLE criteria. Results In total, 302 patients were included, 179 in the gentamicin and 123 in the control group. Mean gentamicin dose was 4.7 ± 0.7 mg/kg. At admission, 26.8% of the gentamicin and 16.3% of the control group had AKI. After admission, AKI occurred in 6.7% of the gentamicin and in 3.3% of the control group (p = 0.30). Occurrence of AKI was not associated with gentamicin administration, but with septic shock (31.2% in patients with AKI vs 9.8% without AKI after admission, p = 0.02). Conclusion This study showed no increased risk of AKI after a single dose of gentamicin to patients with sepsis in the ED, suggesting that a single dose of gentamicin can, with regard to renal function, be safely administered to septic patients.
authors.affiliation: a Department of Internal Medicine , Maastricht University Medical Centre , Maastricht , The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Cobussen
authors.affiliation: a Department of Internal Medicine , Maastricht University Medical Centre , Maastricht , The Netherlands.
authors.forename: Jaclyn M L
authors.initials: JM
authors.lastname: de Kort
authors.affiliation: a Department of Internal Medicine , Maastricht University Medical Centre , Maastricht , The Netherlands.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Dennert
authors.affiliation: a Department of Internal Medicine , Maastricht University Medical Centre , Maastricht , The Netherlands.
authors.forename: Selwyn H
authors.initials: SH
authors.lastname: Lowe
authors.affiliation: a Department of Internal Medicine , Maastricht University Medical Centre , Maastricht , The Netherlands.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Stassen
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy*; D012772:Shock, Septic / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D005839:Gentamicins
keywords: Acute kidney injury; emergency department; gentamicin; nephrotoxicity; sepsis