The incidence of acute kidney injury (AKI) after a single-dose of gentamicin in the emergency department
Kort, J.M.L. de, Cobussen, M., Heuvelmans, P.J.L., Lowe, S.H., Stassen, P.M.
Voorzitter(s): mw. prof.dr. M.M.E. Schneider, Utrecht & dr. W.G. Meijer, Hoorn
Locatie(s): Zaal 0.11
Categorie(ën):
Introduction: Sepsis is associated with high mortality. Empirical therapy with beta lactam (B-lactam) antibiotics and an aminoglycoside can have a survival benefit compared to broad-spectrum B-lactam only. However, aminoglycosides may induce nephrotoxicity. Although data are lacking on the renal safety of a single dose of aminoglycosides in septic patients attending the emergency department (ED), the use of single-dose aminoglycosides is widely accepted in the Netherlands.
Aim of the study: To investigate the occurrence of Acute Kidney Injury (AKI) after a single-dose of gentamicin (5 mg/kg intravenously) and to evaluate possible risk factors.
Materials and Methods: We retrospectively examinedall patients attending our internal medicine ED and fulfilling sepsis criteria from June 2011 until January 2012. Serum creatinine and eGFR (MDRD) were determined at presentation and evaluated during 2 weeks. AKI was defined according to the RIFLE criteria.
Results: In total 303 patients were included, 179 in the combination group and 124 in the B-lactam monotherapy group, with a mean age of 67 ± 17 and 69 ± 16, respectively. The monotherapy group consisted of patients with pneumonia. Baseline creatinine was 144 ± 113 vs 121 ± 94 µmol/l in the combination vs. monotherapy group (p=0.08). Prior to treatment 21% presented at the ED with AKI. AKI after treatment occurred in 12 (7%) of the patients who received gentamycin compared to 5 (4%) in the monotherapy group (p=0.32). The severity of AKI was comparable in both groups “Risk” 2 vs. 2%, “Injury” 3 vs. 2%, “Failure” 2 vs. 1%. The risk of AKI was highest within 48 hours after admission; 12 (4%) vs. 4 (1%) after 48 hours (p=0.002). In-hospital mortality was higher in patients with AKI than in those without AKI (35 vs. 12 %, p = 0.007). The presence of septic shock (OR 18: 95% CI 2-150, p = 0.007), and not the administration of gentamicin or AKI at presentation, was an independent predictor for AKI.
Conclusion: Our study did not revealan increased risk of AKI after a single-dose of gentamicin in internal medicine patients who were admitted via the ED. The occurrence of AKI was associated with septic shock and not with the administration of gentamicin. When AKI occurs in-hospital mortality is higher. Our study shows that single-dose gentamicin can - with regard to renal function - be safely administered in ED patients with sepsis.