Renal impairment after high-dose flucloxacillin and single-dose gentamicin prophylaxis in patients undergoing elective hip and knee replacement

Abstract

We have shown an association between the prophylactic antibiotic regimen and subsequent development of AKI following primary hip and knee arthroplasty that appeared to be due to the use of HD flucloxacillin with single-dose gentamicin. We found no evidence to suggest that this association was confounded by any of the co-variates we measured.

Risk of Acute Kidney Injury with Amikacin versus Gentamycin both in Combination with Metronidazole for Surgical Prophylaxis

“…In our study all patients of AKI recovered in due course of time without any intervention where as in Challangundla et al, study three patients needed temporary haemodialysis [11].…”

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

“…The study conducted by Bell et al consisted of 5 cohorts, with each cohort representing one surgical subspecialty (15). There were 4 study groups in each of the studies done by Challagundla et al (9) and Schneider et al (8), so we coupled each 2 study groups together in order to simplify the comparisons. Figure 2 demonstrates the analysis with all studies included, regardless of surgery type.…”

“…Gentamicin is a common cause of tubular injury, whereas flucloxacillin is an uncommon cause of interstitial nephritis. Challagundla et al reported a significant decrease in the incidence of AKI after reducing the dose of flucloxacillin from 8 to 4 g (9).…”

The Seen and the Unseen

“…The authors performed an observational study of 198 Scottish patients undergoing elective hip or knee surgery between September 2009 and September 2010. 9 Patients who received high-dose flucloxacillin with gentamicin prophylaxis had an increased odds ratio for all severity AKI (14.5; 95% confidence interval [95% CI], 4.2 to 49.7) compared with patients that received cefuroxime alone. Now, Bell et al present a comprehensive population-based analysis of the consequences of this antibiotic policy change.…”

“…Challagundla et al 9 speculated that flucloxacillin was at fault because six of the seven patients with severe AKI (RIFLE class F) were in a high-dose flucloxacillin group and there was a decrease in AKI after reducing the dose of flucloxacillin. In addition, two of three patients who required RRT underwent a kidney biopsy that showed acute tubulointerstitial nephritis, a pathology typical for penicillin-based antibiotics.…”