Antibiotic-associated complications following lower limb arthroplasty: a comparison of two prophylactic regimes

Craxford, Simon; Bayley, Edward; Needoff, M.

doi:10.1007/s00590-013-1348-1

Cited by 21 publications

(27 citation statements)

References 18 publications

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“…Antimicrobial stewardship guidance led many departments to move away from cephalosporins because of the increased risk of Clostridium difficile infection. However, it has been shown that some alternative regimens such as flucloxacillin and gentamicin are associated with increased incidence of AKI 18,[23][24][25] as a result of interstitial nephritis. In our study, there was no increased incidence of AKI with gentamicin/teicoplanin compared with cefuroxime.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury following primary hip and knee arthroplasty surgery

Ferguson

Winter

Russo

et al. 2017

annals

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Acute kidney injury (AKI) is a recognised postoperative complication following primary hip/knee arthroplasty surgery. The aim of this study was to determine causative and potentially modifiable risk factors associated with postoperative AKI. Standard data were collected for 413 consecutive arthroplasty patients, both retrospectively and prospectively. Univariate and multivariate analyses were performed to identify any potential causative factors. Eight percent of patients developed postoperative AKI. Univariate analysis found increasing age, history of previous chronic kidney disease and requirement for postoperative intravenous fluids to be risk factors for AKI. The multivariate regression analysis model identified age and volume of postoperative fluid prescription as predictive of postoperative AKI. Antibiotic regime and prescription of non-steroidal anti-inflammatory drugs had no significant effect on the risk of AKI. No patients required dialysis but length of stay increased by 50% in the AKI group. Postoperative AKI may result in significant postoperative morbidity and increased length of stay, and may necessitate invasive therapies such as dialysis. Episodes of AKI could also predispose to future similar episodes and are associated with a long-term decrease in baseline renal function. This study has demonstrated that the identified risk factors are generally non-modifiable. Further work is suggested to determine whether targeted interventions in high risk patients would reduce the incidence of AKI.

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Section: Discussionmentioning

confidence: 99%

Acute kidney injury following primary hip and knee arthroplasty surgery

Ferguson

Winter

Russo

et al. 2017

annals

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“…There have been a number of studies showing that antibiotic prophylaxis consisting of gentamicin and flucloxacillin is associated with a higher rate of AKI than prophylaxis with cephlosporins (Craxford et al. 2014, Bailey et al. 2014, Bell et al.…”

Section: Discussionmentioning

confidence: 99%

“…2012, Craxford et al. 2014). We are aware that our study did not take account of information about other medications, perioperative bleeding, peri- and postoperative fluid administration, or comorbidity—including previous kidney disease.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of acute kidney injury in hip arthroplasty patients receiving gentamicin and dicloxacillin

2016

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Background and purpose — Acute kidney injury is a known complication of antibiotic use. Antibiotic prophylaxis is essential to prevent periprosthetic infections after total hip replacement. We experienced a rise in the incidence of acute kidney injury (AKI), and in an effort to solve this problem, we changed our antibiotic prophylaxis protocol. We investigated whether removing gentamicin from our antibiotic protocol would cause fewer and less severe cases of renal impairment.Patients and methods — We performed a retrospective study involving 136 cases of total hip replacement, with 66 patients receiving dicloxacillin and gentamicin and 70 patients receiving dicloxacillin alone.Results — We found less cases of AKI in the dicloxacillin group (p = 0.03): the mean creatine level in the dicloxacillin/gentamicin group was 126 (25–422) μmol/L whereas it was 93 (39–278) μmol/L in the group that received dicloxacillin alone. We also found that cases were less severe in the dicloxacillin group than in the dicloxacillin/gentamicin group (p = 0.02). The relative risk of developing AKI was 3 times higher if dicloxacillin and gentamicin were both used (p = 0.02).Interpretation — After removing gentamicin, there were fewer and less severe cases of acute kidney injury

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“…also excluded patients with abnormal baseline renal function although the cutoff GFR was not mentioned (16). Five studies did not mention the use or requirement of renal replacement therapy.…”

Section: Figurementioning

confidence: 99%

“…Gentamicin and penicillin-antibiotic therapy as a surgical prophylaxis carries more risk for the development of AKI for patients undergoing orthopedic surgery as compared to cefuroxime therapy. In a subtype of orthopedic surgery, Craxford et al showed that total knee replacement (TKR) had a significantly higher rate of kidney injury than total hip replacement (THR) (16). They suggested that using pneumatic tourniquet in TKR produced ischemic metabolites and further increased risk of AKI when combined with gentamicin use.…”

Section: Figurementioning

confidence: 99%

Surgical prophylaxis with gentamicin and acute kidney injury: a systematic review and meta-analysis

et al. 2017

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Background: Gentamicin has been increasingly used instead of cephalosporins for surgical prophylaxis in an attempt to reduce the rate of "Clostridium difficile" infection. There are limited data regarding nephrotoxicity related to gentamicin in these patients. Methods:We have conducted a systematic review and meta-analysis to evaluate the risk of acute kidney injury (AKI) in gentamicin-containing surgical prophylactic regimens, compared to regimens without gentamicin, in several types of surgery. Electronic searches were performed using PubMed and Embase, including terms for "AKI, gentamicin, and surgical prophylaxis" with and without MeSH/EMTREE functions. Statistical analysis was then performed using a random-effect model; risk ratios (RR), risk differences (RD) and heterogeneity (I 2 ) were calculated. Funnel plot was used for assessment of publication bias.Results: Eleven studies with fifteen cohorts with 18,354 patients were included in the analysis. Subgroup analysis was performed according to surgery type. We have found that antibiotic prophylaxis with gentamicin containing regimen has significant risk for developing postoperative AKI in orthopedic surgery (RR 2.99; 95% CI: 1.84, 4.88). The results were inconclusive in other types of surgery. Funnel plot indicates potential publication bias.Conclusions: Gentamicin-induced AKI is significant in patients undergoing orthopedic surgery.Physicians should consider risks and benefits of using this regimen in individual patients.

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Antibiotic-associated complications following lower limb arthroplasty: a comparison of two prophylactic regimes

Abstract: Gentamicin with flucloxacillin is comparable with cefuroxime in rates of SSI and RTT but is associated with a significant increase in AKI. AKI is associated with additional morbidity and mortality. This association should be considered when choosing a suitable prophylactic regime.

Cited by 21 publications

References 18 publications

Acute kidney injury following primary hip and knee arthroplasty surgery

Acute kidney injury following primary hip and knee arthroplasty surgery

A retrospective study of acute kidney injury in hip arthroplasty patients receiving gentamicin and dicloxacillin

Surgical prophylaxis with gentamicin and acute kidney injury: a systematic review and meta-analysis

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