BACKGROUND: Gentamicin is often used to treat infective endocarditis (IE). Gentamicin is highly effective, but its applicability is reduced by its nephrotoxic effect. The aim of this study was to quantify the nephrotoxic effect of gentamicin and the association between the nephrotoxic effect and mortality in patients with IE. METHODS: A prospective observational cohort study was performed at 2 tertiary university hospitals in Copenhagen from October 2002 through October 2007; 373 consecutive patients with IE were included. A total of 287 (77%) of the patients received gentamicin treatment (median duration, 14 days); dosage was adjusted according to daily serum creatinine and trough serum gentamicin levels. Kidney function was determined by estimated endogenous creatinine clearance (EECC). Statistical correlation between gentamicin and EECC change was analyzed, and the association between mortality and nephrotoxicity was investigated. RESULTS: The primary bacteriological etiologies were as follows: Streptococcus species (37.1%), Staphylococcus aureus (18.2%), and Enterococcus species (16.1%). In the gentamicin group, the mean EECC change was an 8.6% decrease, but in the no-gentamicin group, the mean change was an increase of 2.3% (P = .05). The decrease in EECC was significantly correlated with the duration of gentamicin treatment: a 0.5% EECC decrease per day of gentamicin treatment (P = .002). The decrease in EECC during hospitalization was not related to postdischarge mortality. The mean duration of follow-up was 562 days. CONCLUSIONS: The nephrotoxic effect of gentamicin is directly related to treatment duration, with a decrease in EECC of 0.5% per day of gentamicin treatment. In patients treated with gentamicin, the in-hospital decrease in EECC was not related to postdischarge mortality. Consequently, this study does not support abolishment of gentamicin in treatment of IE.
BACKGROUND:Gentamicin is often used to treat infective endocarditis (IE). Gentamicin is highly effective, but its applicability is reduced by its nephrotoxic effect. The aim of this study was to quantify the nephrotoxic effect of gentamicin and the association between the nephrotoxic effect and mortality in patients with IE. METHODS: A prospective observational cohort study was performed at 2 tertiary university hospitals in Copenhagen from October 2002 through October 2007; 373 consecutive patients with IE were included. A total of 287 (77%) of the patients received gentamicin treatment (median duration, 14 days); dosage was adjusted according to daily serum creatinine and trough serum gentamicin levels. Kidney function was determined by estimated endogenous creatinine clearance (EECC). Statistical correlation between gentamicin and EECC change was analyzed, and the association between mortality and nephrotoxicity was investigated. RESULTS: The primary bacteriological etiologies were as follows: Streptococcus species (37.1%), Staphylococcus aureus (18.2%), and Enterococcus species (16.1%). In the gentamicin group, the mean EECC change was an 8.6% decrease, but in the no-gentamicin group, the mean change was an increase of 2.3% (P = .05). The decrease in EECC was significantly correlated with the duration of gentamicin treatment: a 0.5% EECC decrease per day of gentamicin treatment (P = .002). The decrease in EECC during hospitalization was not related to postdischarge mortality. The mean duration of follow-up was 562 days. CONCLUSIONS: The nephrotoxic effect of gentamicin is directly related to treatment duration, with a decrease in EECC of 0.5% per day of gentamicin treatment. In patients treated with gentamicin, the in-hospital decrease in EECC was not related to postdischarge mortality. Consequently, this study does not support abolishment of gentamicin in treatment of IE.
Authors: T K Lauridsen; L E Bruun; R V Rasmussen; M Arpi; N Risum; C Moser; H K Johansen; H Bundgaard; C Hassager; N E Bruun Journal: Eur J Clin Microbiol Infect Dis Date: 2012-03-20 Impact factor: 3.267
Authors: Trine K Lauridsen; Kasper K Iversen; Nikolaj Ihlemann; Philip Hasbak; Annika Loft; Anne K Berthelsen; Anders Dahl; Danijela Dejanovic; Elisabeth Albrecht-Beste; Jann Mortensen; Andreas Kjær; Henning Bundgaard; Niels Eske Bruun Journal: Int J Cardiovasc Imaging Date: 2017-01-03 Impact factor: 2.357
Authors: Nicolas Allou; Astrid Bouteau; Jérôme Allyn; Aurélie Snauwaert; Dorothée Valance; Julien Jabot; Bruno Bouchet; Richard Galliot; Laure Corradi; Philippe Montravers; Pascal Augustin Journal: Ann Intensive Care Date: 2016-11-02 Impact factor: 6.925
Authors: Matthieu Legrand; Romain Pirracchio; Anne Rosa; Maya L Petersen; Mark Van der Laan; Jean-Noël Fabiani; Marie-paule Fernandez-gerlinger; Isabelle Podglajen; Denis Safran; Bernard Cholley; Jean-Luc Mainardi Journal: Crit Care Date: 2013-10-04 Impact factor: 9.097