TY - JOUR

T1 - Is single-dose prophylactic gentamicin associated with acute kidney injury in patients undergoing cardiac surgery?

T2 - A matched-pair analysis

AU - Nielsen, Dorthe Viemose

AU - Fedosova, Maria

AU - Hjortdal, Vibeke

AU - Jakobsen, Carl-Johan

N1 - Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

PY - 2014

Y1 - 2014

N2 - OBJECTIVE: Although aminoglycoside treatment has been associated with nephrotoxic effects, single-dose gentamicin has been considered safe in surgery. However, the effect of a single-dose prophylactic aminoglycoside on the risk of acute kidney injury among patients undergoing cardiac surgery remains uncertain.METHODS: A population-based cohort study with matched-pair analysis of 2892 consecutive patients undergoing cardiac surgery at Aarhus University Hospital, Denmark, was performed. Two different prophylactic antibiotic regimens were used during the study period. The patients exposed to a single dose of prophylactic gentamicin were compared with those had not received gentamicin. Statistical analysis for matched data was performed. The data were retrieved from the Western Denmark Heart Registry.RESULTS: Matching resulted in 668 patient pairs. Patients receiving gentamicin had higher maximum serum creatinine during the first postoperative 72 hours (median, 96 vs 90 mmol/L; P=.0002). Also, a greater fraction of patients receiving gentamicin developed acute kidney injury according to the Acute Kidney Injury Network criteria (22% vs 17%; P=.02). The hospital length of stay was shorter in the control group (5.0 vs 5.6 days; P<.0001). No difference was found in the incidence of patients requiring postoperative dialysis, 30-day and 1-year mortality, or the incidence of sternal infection between the 2 groups.CONCLUSIONS: A single-dose prophylactic aminoglycoside in adult cardiac surgery patients was associated with an increased risk of acute kidney injury but not with a greater frequency of postoperative dialysis or mortality. No differences in the incidence of sternal infections between groups were observed.

AB - OBJECTIVE: Although aminoglycoside treatment has been associated with nephrotoxic effects, single-dose gentamicin has been considered safe in surgery. However, the effect of a single-dose prophylactic aminoglycoside on the risk of acute kidney injury among patients undergoing cardiac surgery remains uncertain.METHODS: A population-based cohort study with matched-pair analysis of 2892 consecutive patients undergoing cardiac surgery at Aarhus University Hospital, Denmark, was performed. Two different prophylactic antibiotic regimens were used during the study period. The patients exposed to a single dose of prophylactic gentamicin were compared with those had not received gentamicin. Statistical analysis for matched data was performed. The data were retrieved from the Western Denmark Heart Registry.RESULTS: Matching resulted in 668 patient pairs. Patients receiving gentamicin had higher maximum serum creatinine during the first postoperative 72 hours (median, 96 vs 90 mmol/L; P=.0002). Also, a greater fraction of patients receiving gentamicin developed acute kidney injury according to the Acute Kidney Injury Network criteria (22% vs 17%; P=.02). The hospital length of stay was shorter in the control group (5.0 vs 5.6 days; P<.0001). No difference was found in the incidence of patients requiring postoperative dialysis, 30-day and 1-year mortality, or the incidence of sternal infection between the 2 groups.CONCLUSIONS: A single-dose prophylactic aminoglycoside in adult cardiac surgery patients was associated with an increased risk of acute kidney injury but not with a greater frequency of postoperative dialysis or mortality. No differences in the incidence of sternal infections between groups were observed.

KW - Acute Kidney Injury/chemically induced

KW - Aged

KW - Anti-Bacterial Agents/administration & dosage

KW - Antibiotic Prophylaxis/adverse effects

KW - Cardiac Surgical Procedures

KW - Creatinine/blood

KW - Denmark

KW - Female

KW - Gentamicins/administration & dosage

KW - Humans

KW - Male

KW - Matched-Pair Analysis

KW - Middle Aged

KW - Registries

KW - Risk Factors

KW - Treatment Outcome

U2 - 10.1016/j.jtcvs.2014.05.090

DO - 10.1016/j.jtcvs.2014.05.090

M3 - Journal article

C2 - 25150580

VL - 148

SP - 1634

EP - 1639

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 4

ER -