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

Abstract

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.

Gentamicin-Coated Tibia Nail in Fractures and Nonunion to Reduce Fracture-Related Infections: A Systematic Review

“…Gentamicin belongs to the aminoglycoside group; it is active against Gram negatives and the most common bacterial strains found in orthopedic surgeries or following open fractures, above all staphylococcus species. Although its efficacy is high, gentamicin is not commonly used for systemic antibiotic prophylaxis in orthopedic surgery as it has a small therapeutic index and serious dose-dependent side effects [ 31 ]. It has been shown that the amount of gentamicin released into circulation by coated nails does not reach systemic toxicity levels [ 12 ].…”

Is That Solution for IV or Irrigation? Fluid Administration Errors in the Operating Room

“…However, this medication is particularly dangerous if it is erroneously administered intravenously to a patient undergoing kidney transplantation because it can damage the newly transplanted kidney. Prophylactic gentamicin has recently been shown to be a significant cause of acute kidney injury in orthopedic surgery 5,6 . Inadvertent IV administration of gentamicin therefore constitutes a significant unnecessary risk for the transplanted kidney.…”

Report of Three Cases of AKI Following Weight-Based Gentamicin Prophylaxis for IPP Implantation: Potential Concerns for Patients with Preexisting Conditions

“…AKI occurred despite the reduced gentamicin dose of 2-3 mg/kg ideal body weight (or adjusted body weight if obese). Studies suggest that the majority of gentamicin-associated AKIs are transient and many patients, such as Case 3 , may ultimately return to baseline renal function [4]. However, transient AKI can worsen baseline renal function, as seen in Cases 1 and 2, and even significantly increase the risk of future end-stage renal disease [6].…”

“…However, the study was limited by the lack of any postoperative measures of nephrotoxicity and only evaluated rates of readmission for AKI. Interestingly, the majority of gentamicin-associated cases of AKI are subclinical stage-1 insults, making readmission rates an inadequate outcome measure [4]. In addition, there are no specific recommendations regarding dose adjustment for patients with preexisting conditions such as chronic kidney disease (CKD) or diabetes mellitus (DM) which are highly prevalent in individuals with medication-refractory erectile dysfunction.…”