title: Single high dose gentamicin for perioperative prophylaxis in orthopedic surgery: Evaluation of nephrotoxicity.
abstract: BACKGROUND
  Recent studies described an increase in acute kidney injury when high dose gentamicin was included in perioperative prophylaxis for orthopedic surgeries. To this effect, we compared the rate of nephrotoxicity for selected orthopedic surgeries where gentamicin was included (Gentamicin Group) to those where it was not included (Control Group) for perioperative prophylaxis and evaluated risk factors for nephrotoxicity.
  
  
  METHODS
  Spine, hip and knee surgeries performed between April 2011 and December 2013 were reviewed retrospectively. Gentamicin was given to eligible patients based on age, weight and Creatinine Clearance. Nephrotoxicity was assessed using Risk, Injury, Failure, Loss, End-stage kidney disease (RIFLE) criteria.
  
  
  RESULTS
  Among selected surgeries (N = 1590 in Gentamicin Group: hip = 926, spine = 600, knee = 64; N = 2587 in
  
  
  METHODS
  hip = 980, spine = 902, knee = 705), patients' body weight, serum creatinine, comorbidities and surgery duration were similar in Gentamicin Group and CONTROL GROUP. Gentamicin median dose was 4.5 mg/kg of dosing weight. Nephrotoxicity rate was 2.5% in Gentamicin Group and 1.8% in CONTROL GROUP, p = 0.17. Most cases of nephrotoxicity were Risk category by RIFLE criteria (67% in Gentamicin Group and 72% in CONTROL GROUP, p = 0.49). In logistic regression, risk factors for nephrotoxicity were hospital stay >1 day prior to surgery (odds ratio = 8.1; 95% confidence interval = 2.25-28.97, p = 0.001), knee or hip surgery (odds ratio = 4.7; 95% confidence interval = 2.9-9.48, p = 0.0005) and diabetes (odds ratio = 1.95; 95% confidence interval = 1.13-3.35, p = 0.016). Receipt of gentamicin was not an independent predictor of nephrotoxicity (odds ratio = 1.5; 95% confidence interval = 0.97-2.35, p = 0.07).
  
  
  CONCLUSIONS
  In this cohort, rate of nephrotoxicity was similar between Gentamicin Group and Control Group. Single high dose gentamicin is a safe and acceptable option for perioperative prophylaxis in eligible patients undergoing orthopedic surgeries.
authors.affiliation: Department of Pharmacy, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Yanina
authors.initials: Y
authors.lastname: Dubrovskaya
authors.affiliation: Department of Infection Prevention and Control, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Rainer
authors.initials: R
authors.lastname: Tejada
authors.affiliation: Department of Orthopedic Surgery, Hospital for Joint Diseases and Orthopedic Surgery, New York, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bosco
authors.affiliation: Department of Infection Prevention and Control, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Stachel
authors.affiliation: Department of Infection Prevention and Control, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Infection Prevention and Control, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Feng
authors.affiliation: Department of Anesthesiology, Hospital for Joint Diseases and Orthopedic Surgery, New York, NY, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rosenberg
authors.affiliation: Department of Infection Prevention and Control, NYU Langone Medical Center, New York, NY, USA; Department of Infectious Diseases & Immunology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Phillips
keywords: Gentamicin; high dose; nephrotoxicity; perioperative prophylaxis