The use of initial dosing of gentamicin in the management of pyelonephritis/urosepsis: A retrospective study

Abstract

ObjectiveThe primary objective was to determine if initial empirical intravenous dosing of gentamicin improved patient's outcomes in pyelonephritis/urosepsis compared with alternative IV antibiotic management.DesignRetrospective cross-sectional descriptive study.SettingPublic TertiaryTeaching Hospital serving adults in an urban centre.ParticipantsAll adult patient records with a recorded diagnosis of any of pyelonephritis/urosepsis, urinary tract infection, UTI, complicated urinary tract infection, bacteriuria, symptomatic bacteriuria and asymptomatic bacteriuria from 2nd February 2012 to 10th May 2014 were reviewed. Only patients treated with an empirical regimen of one or more IV antibiotics were included in the study.Main outcomesThe primary outcomes were: duration of IV antibiotic treatment, time to resolution of symptoms and length of hospital stay (LOS). Secondary end points were: compliance with Therapeutic Guidelines: Antibiotic (electronic version) (eTG) for severe pyelonephritis/urosepsis and appropriateness of gentamicin use.Data analysisUnivariate and multivariable associations between baseline and demographic variables and the main outcomes were performed using Chi-square tests and a General Linear Model using the SAS version 9.2 software.ResultsOf 295 patients reviewed 152 were prescribed one or more IV antibiotics and included in the study. Approximately half of the patients (n = 73, 48%) were prescribed IV piperacillin/tazobactam (Tazocin), while gentamicin was prescribed for 66 patients (43.4%). Of the 152 patients evaluated, 49 (32%) were given gentamicin first. Multivariable regression analysis showed that duration of IV treatment was shorter for those aged over 70 (40.2 hours vs 85.5 hours for those aged up to 70; p = 0.0074), and those who received gentamicin as first line treatment (41.3 hours vs 89.8 hours for those not receiving any gentamicin; p = 0.0312). After adjustment for age and gentamicin administration, there appeared to be no significant difference in duration of IV treatment for any other independent variables. No significant associations between the independent variables (gentamicin, age, gender, comorbidities, and eTG compliance) and either time to resolution of symptoms (median: 68 hours) or hospital LOS (median: 5 days) were observed.ConclusionsNeither time to resolution of abnormal symptoms nor length of stay were significantly influenced by an initial dose of gentamicin when the data were subjected to multivariable analysis. The age of the patient and pattern of gentamicin treatment were the dominant factors associated with duration of IV antibiotics. Piperacillin/tazobactam is not recommended in treatment guidelines for pyelonephritis/urosepsis but was the most commonly prescribed IV antibiotic. This requires review by the appropriate hospital clinicians.

Empiric Guideline Therapy for Simple Urinary Tract Infection at Outpatient Clinics: A Prospective Observational Study

“…30 In another study, empirical intravenous ( IV) antibiotic treatment prescribed for 152 patients with severe UTI showed that the overall duration of IV antibiotic treatment was significantly shorter for patients administered gentamicin empirically as initial treatment compared with patients who were not administered gentamicin at all. 31 Hence, we agree with this study and recommend the use of gentamycin as an empirical therapy for a short time, which is also in accordance with the study of Ekmen et al, who concluded that "gentamicin does not affect the hearing test when it is used in the short-term (5-7 days)". 32 The fluctuation among different centers confirms the requirement for local resistance prevalence data to be made available to professionals treating UTIs, particularly where empirical treatment is being utilized for urinary infections.…”

Tatalaksana Urosepsis: Sebuah Tinjauan Sistematis

“…25 Penggunaan antibiotik profilaksis selain karbapenem memiliki kecenderungan urosepsis lebih tinggi (31,6% vs. 9,5%, p = 0,057). 26 Menurut Ryan, James et al 27 , bahwa penggunaan co-amoxiclav (52%), memiliki pola resistensi tertinggi dibanding antibiotik yang lain, karena tingginya penggunaan, antibiotik dengan angka resistensi yang tinggi memiliki potensi menjadi urosepsis dengan multi-drug resistant (MDR), sehingga perlu dihindari. 14 Bakteri gram negatif merupakan penyebab terbanyak urosepsis, terutama Escherichia coli dan Klebsiella pneumoniae.…”

“…Studi lain mengatakan bahwa penggunaan kombinasi dengan gentamisin (4 -6 mg/kg dosis tunggal IV) tidak memberikan hasil yang signifikan dalam terhadap lama rawatan (median = 5 hari) 27 . Hal ini tidak menghasilkan kesimpulan yang sama dengan penelitian dasar pada negara yang sama, yang menyebutkan penggunaan 54% strain E. coli pada urine, sensitif terhadap penggunaan gentamisin.…”

“…37 Namun, terdapat catatan dari penggunaan gentamisin memiliki IV treatment lebih cepat pada pasien usia >70 tahun dibanding pada usia <70 tahun (40,2 jam vs 85,5 jam; p = 0,0074), dan juga dibanding dengan yang tidak menerima gentamisin sebagai terapi utama (41,3 jam vs 89,8 jam; p = 0,0312). 27 Terapi Spesifik serta Eliminasi Terapi yang bersifat spesifik dan eliminasi adalah terapi tambahan dalam mencegah perburukan komplikasi berdasarkan etiologi dari urosepsis. Pada kasus batu saluran kemih, disebutkan bahwa tindakan elective ureteroscopy dalam 6-12 minggu post ureteroscopy lithotripsy dengan urosepsis, sebelumnya diikuti emergency drainase melalui stent, berdasarkan studi, beberapa pasien bisa pulang di hari yang sama (ASA ≥ 3, dengan klinis yang baik).…”

Protective Effects of Liposomal Curcumin on Oxidative Stress/Antioxidant Imbalance, Metalloproteinases 2 and -9, Histological Changes and Renal Function in Experimental Nephrotoxicity Induced by Gentamicin

“…The use of gentamicin, in parenteral administration, has shown significant better infection outcomes involving some gram-negative bacteria such as Escherichia coli , Klebsiella pneumoniae , Pseudomonas aeruginosa , and was also efficient against some other strains such as Neisseria [ 5 , 6 , 7 ]. Gentamicin also proved to be efficient in bacterial septicemia, meningitis, peritonitis, endocarditis, pneumonia, urinary tract infections, or odontogenic infections [ 8 ].…”