Risk of AKI with gentamicin as surgical prophylaxis

Samira Bell, Peter Davey, Dilip Nathwani, Charis Marwick, Thenmalar Vadiveloo, Jacqueline Sneddon, Andrea Patton, Marion Bennie, Stewart Fleming, Peter T. Donnan

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Abstract

In 2009, the Scottish government issued a target to reduce Clostridium difficile infection by 30% in 2 years. Consequently, Scottish hospitals changed from cephalosporins to gentamicin for surgical antibiotic prophylaxis. This study examined rates of postoperative AKI before and after this policy change. The study population comprised 12,482 adults undergoing surgery (orthopedic, urology, vascular, gastrointestinal, and gynecology) with antibiotic prophylaxis between October 1, 2006, and September 30, 2010 in the Tayside region of Scotland. Postoperative AKI was defined by the Kidney Disease Improving Global Outcomes criteria. The study design was an interrupted time series with segmented regression analysis. In orthopedic patients, change in policy from cefuroxime to flucloxacillin (two doses of 1 g) and single-dose gentamicin (4 mg/kg) was associated with a 94% increase in AKI (P=0.04; 95% confidence interval, 93.8% to 94.3%). Most patients who developed AKI after prophylactic gentamicin had stage 1 AKI, but some patients developed persistent stage 2 or stage 3 AKI. The antibiotic policy change was not associated with a significant increase in AKI in the other groups. Regardless of antibiotic regimen, however, rates of AKI were high (24%) after vascular surgery, and increased steadily after gastrointestinal surgery. Rates could only be ascertained in 52% of urology patients and 47% of gynecology patients because of a lack of creatinine testing. These results suggest that gentamicin should be avoided in orthopedic patients in the perioperative period. Our findings also raise concerns about the increasing prevalence of postoperative AKI and failures to consistently measure postoperative renal function.

Original languageEnglish
Pages (from-to)2625-2632
Number of pages8
JournalJournal of the American Society of Nephrology
Volume25
Issue number11
Early online date29 May 2014
DOIs
Publication statusPublished - 1 Nov 2014

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Keywords

  • clostridium difficile
  • Scottish hospitals
  • antibiotic prophylaxis
  • postoperative AKI

Cite this

Bell, S., Davey, P., Nathwani, D., Marwick, C., Vadiveloo, T., Sneddon, J., ... Donnan, P. T. (2014). Risk of AKI with gentamicin as surgical prophylaxis. Journal of the American Society of Nephrology, 25(11), 2625-2632. https://doi.org/10.1681/ASN.2014010035