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Nephrotoxicity associated with short-term gentamicin therapy in community-acquired bacteraemia: risk of
Oliver Wagner Ulf Nielsen1, Mikkel Oliver Skov Risom1, Hans Linde Nielsen2,3
1Department of Infectious Diseases, Aalborg University Hospital.
Introduction:
Hesitancy towards the use of aminoglycosides persists among clinicians due to the perceived risk of nephrotoxicity.
Methods:
This retrospective cohort study included adults with community-acquired bacteraemia and no pre-existing renal failure. The patients were divided into two groups matched 1:1 by age (± 5 years): 1) patients treated with short-term (≤ 3 days) once-daily gentamicin within 24 hours of admission and 2) non-gentamicin-treated patients. The primary endpoint was an increase in plasma creatinine levels of ≥ 40 µmol/l from baseline. Cause-specific Cox regression was used to compute hazard ratios (HR) with 95% confidence intervals (CI) for prognostic factors of acute kidney injury (AKI) and death.
Results:
A total of 310 adults with bacteraemia were included, among whom 159 (49%) were treated with gentamicin and 151 (51%) with other antibiotics. No significant between-group differences were observed in sex distribution, comorbidities, biochemical variables and vital signs at admission. In the gentamicin-exposed group, 11 (7%) patients developed AKI compared with 12 (8%) patients in the non-exposed group. Gentamicin was neither associated with increased risk of AKI (HR = 0.86; 95% CI: 0.38-1.96) nor with 30-day mortality (HR = 0.73; 95% CI: 0.38-1.41) compared with other antibiotic regimens.
Conclusions:
Our study showed no increase in the risk of developing AKI and no increase in all-cause mortality in patients treated with short-term once-daily gentamicin for community-acquired bacteraemia compared with other antibiotic regimens.
Funding:
None.
Trial Registration:
Not relevant.
Insights
Short-term, once-daily gentamicin for community-acquired bacteraemia did not increase the risk of acute kidney injury (AKI) or mortality. This study found gentamicin to be a safe treatment option when compared to other antibiotic regimens.
Area of Science:
- Infectious Diseases
- Nephrology
- Clinical Pharmacology
Background:
- Clinician hesitancy regarding aminoglycoside use, particularly gentamicin, stems from concerns about potential nephrotoxicity.
- This perception may limit the utilization of effective antibiotic treatments.
Purpose of the Study:
- To evaluate the safety of short-term, once-daily gentamicin administration in patients with community-acquired bacteraemia.
- To compare the incidence of acute kidney injury (AKI) and 30-day mortality between gentamicin-treated and non-gentamicin-treated patients.
Main Methods:
- Retrospective cohort study of 310 adult patients with community-acquired bacteraemia and no prior renal failure.
- Patients were matched 1:1 based on age, with one group receiving short-term (≤3 days) once-daily gentamicin and the other receiving alternative antibiotics.
- Primary endpoint was a ≥40 µmol/l increase in plasma creatinine; Cox regression analyzed AKI and mortality risk.
Main Results:
- No significant differences in baseline characteristics were observed between the 159 gentamicin-treated and 151 non-gentamicin-treated patients.
- The incidence of AKI was similar: 7% in the gentamicin group versus 8% in the non-exposed group.
- Gentamicin use was not associated with an increased risk of AKI (HR=0.86) or 30-day mortality (HR=0.73) compared to other antibiotics.
Conclusions:
- Short-term, once-daily gentamicin is a safe treatment for community-acquired bacteraemia.
- The study demonstrates no increased risk of acute kidney injury or all-cause mortality with gentamicin use in this patient population.
- Findings may help alleviate clinician concerns regarding gentamicin-induced nephrotoxicity.
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