Severity of gentamicin's nephrotoxic effect on patients with infective endocarditis: a prospective observational cohort study of 373 patients

Kristine Buchholtz; Carsten T Larsen; Christian Hassager; Niels E Bruun

doi:10.1086/594122

Severity of gentamicin's nephrotoxic effect on patients with infective endocarditis: a prospective observational cohort study of 373 patients

Kristine Buchholtz, Carsten T Larsen, Christian Hassager, Niels E Bruun

Hjertesygdomme

61 Citationer (Scopus)

Abstract

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.

Originalsprog	Engelsk
Tidsskrift	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Vol/bind	48
Udgave nummer	1
Sider (fra-til)	65-71
Antal sider	7
ISSN	1058-4838
DOI	https://doi.org/10.1086/594122
Status	Udgivet - 1 jan. 2009

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10.1086/594122

Citationsformater

Severity of gentamicin's nephrotoxic effect on patients with infective endocarditis: a prospective observational cohort study of 373 patients. / Buchholtz, Kristine; Larsen, Carsten T; Hassager, Christian et al.
I: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Bind 48, Nr. 1, 01.01.2009, s. 65-71.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

@article{b817d63879cb41138057329164e57f3d,

title = "Severity of gentamicin's nephrotoxic effect on patients with infective endocarditis: a prospective observational cohort study of 373 patients",

abstract = "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.",

keywords = "Acute Kidney Injury, Aged, Cohort Studies, Creatinine, Denmark, Endocarditis, Enterococcus, Female, Gentamicins, Gram-Positive Bacterial Infections, Humans, Kidney, Male, Metabolic Clearance Rate, Middle Aged, Prospective Studies, Staphylococcus aureus, Statistics as Topic, Streptococcus, Time Factors",

author = "Kristine Buchholtz and Larsen, {Carsten T} and Christian Hassager and Bruun, {Niels E}",

year = "2009",

month = jan,

day = "1",

doi = "10.1086/594122",

language = "English",

volume = "48",

pages = "65--71",

journal = "Clinical infectious diseases : an official publication of the Infectious Diseases Society of America",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "1",

}

TY - JOUR

T1 - Severity of gentamicin's nephrotoxic effect on patients with infective endocarditis

T2 - a prospective observational cohort study of 373 patients

AU - Buchholtz, Kristine

AU - Larsen, Carsten T

AU - Hassager, Christian

AU - Bruun, Niels E

PY - 2009/1/1

Y1 - 2009/1/1

N2 - 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.

AB - 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.

KW - Acute Kidney Injury

KW - Aged

KW - Cohort Studies

KW - Creatinine

KW - Denmark

KW - Endocarditis

KW - Enterococcus

KW - Female

KW - Gentamicins

KW - Gram-Positive Bacterial Infections

KW - Humans

KW - Kidney

KW - Male

KW - Metabolic Clearance Rate

KW - Middle Aged

KW - Prospective Studies

KW - Staphylococcus aureus

KW - Statistics as Topic

KW - Streptococcus

KW - Time Factors

U2 - 10.1086/594122

DO - 10.1086/594122

M3 - Journal article

C2 - 19046065

SN - 1058-4838

VL - 48

SP - 65

EP - 71

JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

IS - 1

ER -

Severity of gentamicin's nephrotoxic effect on patients with infective endocarditis: a prospective observational cohort study of 373 patients

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