title: Surgical prophylaxis with gentamicin and acute kidney injury: a systematic review and meta-analysis.
abstract: BACKGROUND
  Gentamicin has been increasingly used instead of cephalosporins for surgical prophylaxis in an attempt to reduce the rate of "Clostridium difficile" infection. There are limited data regarding nephrotoxicity related to gentamicin in these patients.
  
  
  METHODS
  We have conducted a systematic review and meta-analysis to evaluate the risk of acute kidney injury (AKI) in gentamicin-containing surgical prophylactic regimens, compared to regimens without gentamicin, in several types of surgery. Electronic searches were performed using PubMed and Embase, including terms for "AKI, gentamicin, and surgical prophylaxis" with and without MeSH/EMTREE functions. Statistical analysis was then performed using a random-effect model; risk ratios (RR), risk differences (RD) and heterogeneity (I2) were calculated. Funnel plot was used for assessment of publication bias.
  
  
  RESULTS
  Eleven studies with fifteen cohorts with 18,354 patients were included in the analysis. Subgroup analysis was performed according to surgery type. We have found that antibiotic prophylaxis with gentamicin containing regimen has significant risk for developing postoperative AKI in orthopedic surgery (RR 2.99; 95% CI: 1.84, 4.88). The results were inconclusive in other types of surgery. Funnel plot indicates potential publication bias.
  
  
  CONCLUSIONS
  Gentamicin-induced AKI is significant in patients undergoing orthopedic surgery. Physicians should consider risks and benefits of using this regimen in individual patients.
authors.affiliation: Division of Nephrology and Hypertension, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Weeraporn
authors.initials: W
authors.lastname: Srisung
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Jirapat
authors.initials: J
authors.lastname: Teerakanok
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Pakpoom
authors.initials: P
authors.lastname: Tantrachoti
authors.affiliation: Mahidol University, Bangkok, Thailand.
authors.forename: Amputch
authors.initials: A
authors.lastname: Karukote
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent
keywords: Acute kidney injury (AKI); antibiotic prophylaxis; gentamicin; surgical prophylaxis