Single high dose gentamicin for perioperative prophylaxis in orthopedic surgery: Evaluation of nephrotoxicity

Abstract

Background:Recent studies described an increase in acute kidney injury when high dose gentamicin was included in perioperative prophylaxis for orthopedic surgeries. To this effect, we compared the rate of nephrotoxicity for selected orthopedic surgeries where gentamicin was included (Gentamicin Group) to those where it was not included (Control Group) for perioperative prophylaxis and evaluated risk factors for nephrotoxicity.Methods:Spine, hip and knee surgeries performed between April 2011 and December 2013 were reviewed retrospectively. Gentamicin was given to eligible patients based on age, weight and Creatinine Clearance. Nephrotoxicity was assessed using Risk, Injury, Failure, Loss, End-stage kidney disease (RIFLE) criteria.Results:Among selected surgeries (N = 1590 in Gentamicin Group: hip = 926, spine = 600, knee = 64; N = 2587 in Control Group: hip = 980, spine = 902, knee = 705), patients’ body weight, serum creatinine, comorbidities and surgery duration were similar in Gentamicin Group and Control Group. Gentamicin median dose was 4.5 mg/kg of dosing weight. Nephrotoxicity rate was 2.5% in Gentamicin Group and 1.8% in Control Group, p = 0.17. Most cases of nephrotoxicity were Risk category by RIFLE criteria (67% in Gentamicin Group and 72% in Control Group, p = 0.49). In logistic regression, risk factors for nephrotoxicity were hospital stay >1 day prior to surgery (odds ratio = 8.1; 95% confidence interval = 2.25–28.97, p = 0.001), knee or hip surgery (odds ratio = 4.7; 95% confidence interval = 2.9–9.48, p = 0.0005) and diabetes (odds ratio = 1.95; 95% confidence interval = 1.13–3.35, p = 0.016). Receipt of gentamicin was not an independent predictor of nephrotoxicity (odds ratio = 1.5; 95% confidence interval = 0.97–2.35, p = 0.07).Conclusion:In this cohort, rate of nephrotoxicity was similar between Gentamicin Group and Control Group. Single high dose gentamicin is a safe and acceptable option for perioperative prophylaxis in eligible patients undergoing orthopedic surgeries.

Adverse effects of a single dose of gentamicin in adults: a systematic review

“…Thirty‐six studies were included in the final synthesis: one thesis and 35 journal articles . The 36 studies included 11 randomized controlled studies (two crossover designs), 18 cohort studies, one retrospective survey, three pharmacokinetic and three quasiexperimental studies.…”

“…Reported adverse events are summarized in Table . Twenty‐three , of the 36 included studies, reported adverse events in the gentamicin arm of their study although not all adverse events were related to gentamicin. Pons et al .…”

“…A significant number of studies have been published in the last 3 years, almost as many as in the previous 50 years. The majority of these recent studies are a form of cohort study, without randomization.…”

“…The majority of these recent studies are a form of cohort study, without randomization. Many of the studies reviewed a change in local antibiotic policies, particularly within orthopaedic surgery . Authors compared a cephalosporin with gentamicin plus another antibiotic, frequently flucloxacillin.…”

“…Seventeen studies reported nephrotoxicity following gentamicin. A definition of nephrotoxicity or AKI was often absent or varied between studies (Figure ).…”