Related Experiment Videos

Renal impairment after high-dose flucloxacillin and single-dose gentamicin prophylaxis in patients undergoing

Sudhakar Rao Challagundla1, David Knox, Amanda Hawkins

  • 1Department of Orthopaedics, Dumfries and Galloway RoyalInfirmary, Dumfries, UK.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|December 1, 2012
PubMed
Abstract

Insights

High-dose flucloxacillin with gentamicin significantly increased the risk of acute kidney injury (AKI) in hip and knee replacement surgery patients. This antibiotic regimen should be used cautiously to prevent AKI in surgical prophylaxis.

Area of Science:

  • Nephrology
  • Orthopedic Surgery
  • Infectious Disease

Background:

  • The Scottish Antimicrobial Prescribing Group recommended switching antibiotic prophylaxis for hip and knee replacements from cefuroxime to flucloxacillin with gentamicin to reduce Clostridium difficile associated diarrhoea (CDAD).
  • A clinical observation suggested an increase in acute kidney injury (AKI) post-surgery following this antibiotic switch.

Purpose of the Study:

  • To investigate the association between a change in prophylactic antibiotic regimen and the incidence of AKI in patients undergoing elective hip or knee replacement surgery.
  • To evaluate the safety of flucloxacillin with gentamicin compared to cefuroxime for surgical prophylaxis in arthroplasty.

Main Methods:

  • A retrospective study examined AKI incidence in 198 patients receiving different prophylactic antibiotic regimens: cefuroxime, high-dose (HD) flucloxacillin with gentamicin, low-dose (LD) flucloxacillin with gentamicin, and cefuroxime again.
  • AKI was assessed using RIFLE criteria. Multivariate logistic regression was used to adjust for potential confounders.

Main Results:

  • The incidence of AKI was significantly higher in the HD flucloxacillin with gentamicin group (52%) compared to cefuroxime (8% and 14%) and LD flucloxacillin with gentamicin (22%).
  • Patients receiving HD flucloxacillin with gentamicin had a 14.53-fold increased odds of AKI (95% CI 4.25-49.71).
  • Three patients required haemodialysis, all from the HD flucloxacillin group, with biopsies showing acute tubulo-interstitial nephritis.

Conclusions:

  • The prophylactic use of high-dose flucloxacillin with single-dose gentamicin is associated with a significant increase in AKI following hip and knee arthroplasty.
  • The observed association was not confounded by measured covariates, highlighting the potential nephrotoxicity of this specific antibiotic combination.

Related Concept Videos

Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations01:15

Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations

Gentamicin, an aminoglycoside antibiotic, is commonly administered via intermittent intravenous infusion to treat severe infections. An intermittent one-hour infusion of gentamicin, administered at eight-hour intervals, allows for precise control of plasma drug concentrations, minimizing toxicity while ensuring therapeutic efficacy. Pharmacokinetic principles govern the dynamics of plasma concentrations and can be mathematically described using specific equations.The plasma drug concentration...
Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...
Drug Accumulation During Multiple Dosing: Intermittent IV Infusions01:24

Drug Accumulation During Multiple Dosing: Intermittent IV Infusions

Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...