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Büchele G, Rehm M, Halbgebauer R, Rothenbacher D, Huber-Lang M. Trauma-related acute kidney injury during inpatient care of femoral fractures increases the risk of mortality: A claims data analysis. AMERICAN JOURNAL OF MEDICINE OPEN 2022; 8:100009. [PMID: 39036514 PMCID: PMC11256273 DOI: 10.1016/j.ajmo.2022.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 07/23/2024]
Abstract
Objectives: Although femoral fractures can hit anyone, they carry an especially high burden in the elderly and are multifaceted in their injury pattern, related complications, and subsequent therapeutic strategies. An often underestimated posttraumatic risk is the development of trauma-related acute kidney injury (TRAKI). However, for TRAKI, no outcome study with a large data approach exists addressing fractures. Therefore, we analyzed the development of TRAKI in regard to different covariates and quantified the association of TRAKI with overall mortality. Design: Retrospective cohort study with claims data. Setting and participants: 119,000 patients from Germany with femur fracture. Methods: We calculated cumulative mortality, mortality rates per 100 person-years (both occurring within 180 days after fracture), and adjusted hazard ratios with 95%-confidence intervals (CI). Results: Patients with femur shaft fractures showed an incidence of 6.1% for TRAKI, followed by patients with femur neck fractures with an incidence of 5.7%, and by patients with distal fractures with an incidence of 4.5%, respectively. Overall, in patients with any femur fracture, we found a 3.17-times higher mortality rate (95%-CI: 3.02-3.26) during 180 days of observation in patients who developed TRAKI in comparison to patients without. The risk for development of TRAKI was significantly increased with increasing TRAKI stage, age, and time until surgical intervention. Conclusions and implications: In conclusion, patients suffering from proximal-, shaft-, and distal femoral fracture face an over 3-times higher 180 day-mortality rate in case of posttraumatic TRAKI, which should be considered in peri-traumatic care to improve the long-term outcome of these patients.
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Affiliation(s)
- Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm 89081, Germany
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm 89081, Germany
| | - Rebecca Halbgebauer
- Institute of Clinical and Experimental Trauma-Immunology (ITI), University of Ulm, Germany
| | | | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology (ITI), University of Ulm, Germany
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Chinzowu T, Roy S, Nishtala PS. Risk of antimicrobial-associated organ injury among the older adults: a systematic review and meta-analysis. BMC Geriatr 2021; 21:617. [PMID: 34724889 PMCID: PMC8561875 DOI: 10.1186/s12877-021-02512-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background Older adults (aged 65 years and above) constitute the fastest growing population cohort in the western world. There is increasing evidence that the burden of infections disproportionately affects older adults, and hence this vulnerable population is frequently exposed to antimicrobials. There is currently no systematic review summarising the evidence for organ injury risk among older adults following antimicrobial exposure. This systematic review and meta-analysis examined the relationship between antimicrobial exposure and organ injury in older adults. Methodology We searched for original research articles in PubMed, Embase.com, Web of Science core collection, Web of Science BIOSIS citation index, Scopus, Cochrane Central Register of Controlled Trials, ProQuest, and PsycINFO databases, using key words in titles and abstracts, and using MeSH terms. We searched for all available articles up to 31 May 2021. After removing duplicates, articles were screened for inclusion into or exclusion from the study by two reviewers. The Newcastle-Ottawa scale was used to assess the risk of bias for cohort and case-control studies. We explored the heterogeneity of the included studies using the Q test and I2 test and the publication bias using the funnel plot and Egger’s test. The meta-analyses were performed using the OpenMetaAnalyst software. Results The overall absolute risks of acute kidney injury among older adults prescribed aminoglycosides, glycopeptides, and macrolides were 15.1% (95% CI: 12.8–17.3), 19.1% (95% CI: 15.4–22.7), and 0.3% (95% CI: 0.3–0.3), respectively. Only 3 studies reported antimicrobial associated drug-induced liver injury. Studies reporting on the association of organ injury and antimicrobial exposure by age or duration of treatment were too few to meta-analyse. The funnel plot and Egger’s tests did not indicate evidence of publication bias. Conclusion Older adults have a significantly higher risk of sustaining acute kidney injury when compared to the general adult population. Older adults prescribed aminoglycosides have a similar risk of acute kidney injury to the general adult population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02512-3.
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Affiliation(s)
- Tichawona Chinzowu
- Department of Pharmacy and Pharmacology & Centre for Therapeutic Innovation, University of Bath, Bath, BA2 7AY, UK.
| | - Sandipan Roy
- Department of Mathematical Science, University of Bath, Bath, BA2 7AY, UK
| | - Prasad S Nishtala
- Department of Pharmacy and Pharmacology & Centre for Therapeutic Innovation, University of Bath, Bath, BA2 7AY, UK
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Li ZC, Pu YC, Wang J, Wang HL, Zhang YL. The prevalence and risk factors of acute kidney injury in patients undergoing hip fracture surgery: a meta-analysis. Bioengineered 2021; 12:1976-1985. [PMID: 34034633 PMCID: PMC8806851 DOI: 10.1080/21655979.2021.1926200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Acute kidney injury (AKI) was a frequent complication following hip fracture surgery, but recent studies reported inconsistent findings. Our study was aimed at clarifying the prevalence and risk factors of AKI after hip fracture surgery. Pubmed, Embase, and Web of Science were systematically searched from the inception to March 2020 to identify observational studies investigating the prevalence and risk factors of AKI in patients undergoing hip fracture surgery. Pooled prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Publication bias was evaluated with a funnel plot and statistical test. All the statistical analyses were performed using Stata version 12.0. A total of 11 studies with 16,421 patients was included in the current meta-analysis. The pooled prevalence of AKI in patients undergoing hip fracture surgery was 17% (95%CI, 14%-21%) with substantial heterogeneity (I2 = 95%). Postoperative serum albumin (OR 1.80; 95%CI, 1.38-2.36) was a significant predictor for AKI. Age (OR 1.01; 95%CI, 0.95-1.07) and ACE inhibitors (OR 1.38; 95%CI, 0.92-2.07) were associated with increased the risk of AKI, but the results were not statistically significant. No significant publication bias was identified through statistical tests (Egger's test, p = 0.258 and Begg's test, p = 0.087). In conclusion, our findings indicated that the pooled AKI following hip fracture surgery was approximately 17%. Postoperative serum albumin was a potential significant risk factor for AKI.
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Affiliation(s)
- Zi-Cai Li
- Department of Orthopaedics, Wuwei People's Hospital, Wuwei, China
| | - Yan-Chuan Pu
- Department of Orthopaedics, Wuwei People's Hospital, Wuwei, China
| | - Jin Wang
- Department of Orthopaedics, Wuwei People's Hospital, Wuwei, China
| | - Hu-Lin Wang
- Department of Orthopaedics, Wuwei People's Hospital, Wuwei, China
| | - Yan-Li Zhang
- Department of Orthopaedics, Wuwei People's Hospital, Wuwei, China
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Abstract
Upper extremity gunshot wounds result in notable morbidity for the orthopaedic trauma patient. Critical neurovascular structures are particularly at risk. The fractures are often comminuted and may be associated with a variable degree of soft-tissue injury. The literature lacks consensus regarding antibiotic selection and duration, and indications for surgical débridement. Bullets and/or bullet fragments should be removed in cases of plumbism, intra-articular location, nerve impingement, location within a vessel, and location in a subcutaneous position within the hand and/or wrist. Gunshot fractures generally do not follow common fracture patterns seen in blunt injuries, and the complexity of certain gunshot fractures can often be a challenge for the treating orthopaedic surgeon. Common plate and screw constructs may not adequately stabilize these injuries, and innovative fixation techniques may be required. The treatment for bone defects varies by location and severity of injury, and typically requires staged treatment. Nerve injuries after gunshot wounds are common, but spontaneous nerve recovery is expected in most cases.
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Moore RH, Anele UA, Krzastek SC, Klausner AP, Roseman JT. Potential Association of Weight-Based Gentamicin with Increased Acute Kidney Injury in Urologic Prosthetic Surgery. J Sex Med 2018; 16:137-144. [PMID: 30509506 DOI: 10.1016/j.jsxm.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/21/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite the known nephrotoxicity of gentamicin, in 2008 the American Urological Association recommended a weight-based gentamicin dose of 5 mg/kg for antimicrobial prophylaxis during urologic prosthetic surgery. AIM To identify and characterize rates of acute kidney injury (AKI) in urologic prosthetic surgery, both before and after the implementation of weight-based gentamicin dosing. METHODS We performed a single-institution retrospective study of patients receiving perioperative gentamicin during implant, revision, salvage, or explant of inflatable penile prostheses, malleable penile prostheses, or artificial urinary sphincters between the years 2000 and 2017. Patients were stratified into 2 groups, based on administration of either weight-based gentamicin (5 mg/kg or 2-3 mg/kg in cases of poor renal function) or standard-dose gentamicin (80 mg). Patient characteristics and perioperative outcomes were identified. Patients with available preoperative and postoperative (≤7 days) serum creatinine values were included. AKI was defined by Kidney Disease: Improving Global Outcomes criteria. Comparative analyses were performed between groups. MAIN OUTCOME MEASURE Our primary outcome was incidence of AKI, with secondary outcomes including device infection rate and length of stay. RESULTS Of the 415 urologic prosthetic surgeries performed during the study period, 124 met inclusion criteria with paired preoperative and postoperative serum creatinine values. 57 received weight-based gentamicin (median dose 5.06 mg/kg, interquartile range [IQR] 3.96-5.94) and 67 received standard-dose gentamicin (median dose 1.07 mg/kg, IQR 1.04-1.06), P < .001. There were no significant differences in preoperative renal function or comorbidities between groups; however, the weight-based group was older (median age 64.0 years, IQR 60.0-68.5) compared with the standard-dose group (median age 61.0 years, IQR 55.0-66.0), P = .01, and comprised fewer explant cases (1.8%, 1 of 57) than the standard-dose group (13.4%, 9 of 67), P = .02. The AKI rate was significantly higher in the weight-based group (15.8%, 9 of 57) compared with the standard-dose group (3.0%, 2 o67), P = .02. Device infection rate was similar between groups (5.3%, 3/56 vs 5.2%, 3 of 58), P = 1.00. CLINICAL IMPLICATIONS Our data suggest weight-based perioperative gentamicin prophylaxis may be associated with an increased AKI risk, without noticeably improving infection rates. STRENGTH & LIMITATIONS Strengths of our study include the Veterans Affairs population analyzed, as well as rigorous inclusion criteria that allowed for a sensitive assessment of postoperative renal function. Limitations include the retrospective design and small sample size. CONCLUSION Weight-based gentamicin dosing may warrant closer perioperative monitoring of renal function, and merits larger investigations to further elucidate risks and benefits. Moore RH, Anele UA, Krzastek SC. Potential Association of Weight-Based Gentamicin with Increased Acute Kidney Injury in Urologic Prosthetic Surgery. J Sex Med 2019;16:137-144.
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Affiliation(s)
- R Hart Moore
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Uzoma A Anele
- Division of Urology, Virginia Commonwealth University Medical Center, West Hospital, Richmond, VA, USA; Division of Urology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Sarah C Krzastek
- Division of Urology, Virginia Commonwealth University Medical Center, West Hospital, Richmond, VA, USA; Division of Urology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Adam P Klausner
- Division of Urology, Virginia Commonwealth University Medical Center, West Hospital, Richmond, VA, USA; Division of Urology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.
| | - J Tyler Roseman
- Division of Urology, Virginia Commonwealth University Medical Center, West Hospital, Richmond, VA, USA; Division of Urology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
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Hayward RS, Harding J, Molloy R, Land L, Longcroft-Neal K, Moore D, Ross JDC. Adverse effects of a single dose of gentamicin in adults: a systematic review. Br J Clin Pharmacol 2017; 84:223-238. [PMID: 28940715 DOI: 10.1111/bcp.13439] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/01/2017] [Accepted: 09/09/2017] [Indexed: 01/15/2023] Open
Abstract
AIMS To systematically review the frequency and type of adverse events associated with a single dose of intravenous or intramuscular gentamicin in adults, for any indication, in studies where a comparator was available. METHODS A review protocol was developed and registered (PROSPERO: CRD42013003229). Studies were eligible for review if they: recruited participants aged ≥16 years; used gentamicin intramuscularly or intravenously as a single one-off dose; compared gentamicin to another medication or placebo; and monitored adverse events. MEDLINE, EMBASE, Cochrane Library, trial registries, conference proceedings and other relevant databases were searched up to November 2016. Risk of bias was assessed on all included studies. RESULTS In total, 15 522 records were identified. After removal of duplicates, screening of title/abstracts for relevance and independent selection of full texts by two reviewers, 36 studies were included. Across all the included studies, 24 107 participants received a single one-off dose of gentamicin (doses ranged from 1 mg kg-1 to 480 mg per dose). Acute kidney injury was described in 2520 participants receiving gentamicin. The large majority of cases were reversible. There were no cases of ototoxicity reported in patients receiving gentamicin. A meta-analysis was not performed due to study heterogeneity. CONCLUSIONS A significant number of patients saw a transient rise in creatinine after a single dose of gentamicin at doses up to 480 mg. Persistent renal impairment and other adverse events were relatively rare.
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Affiliation(s)
- Rachel S Hayward
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Jan Harding
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Rob Molloy
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Lucy Land
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Kate Longcroft-Neal
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan D C Ross
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
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Srisung W, Teerakanok J, Tantrachoti P, Karukote A, Nugent K. Surgical prophylaxis with gentamicin and acute kidney injury: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:100. [PMID: 28361065 DOI: 10.21037/atm.2017.03.06] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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 (I2) 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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Affiliation(s)
- Weeraporn Srisung
- Division of Nephrology and Hypertension, Weill Cornell Medical College, New York, NY, USA
| | - Jirapat Teerakanok
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Pakpoom Tantrachoti
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Bond SE, Boutlis CS, Jansen SG, Miyakis S. Discontinuation of peri-operative gentamicin use for indwelling urinary catheter manipulation in orthopaedic surgery. ANZ J Surg 2016; 87:E199-E203. [PMID: 27255575 DOI: 10.1111/ans.13642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gentamicin has historically been used prior to insertion and removal of indwelling urinary catheters (IDCs) around elective joint replacement surgery to prevent infection; however, this indication is not recognized in the Australian Therapeutic Guidelines: Antibiotic and the paradigm for safe use of gentamicin has shifted. METHODS The antimicrobial stewardship team of a 500 bed tertiary regional hospital performed a retrospective clinical study of gentamicin IDC prophylaxis around total hip and knee arthroplasties. Results were presented to the orthopaedic surgeons. A literature review identified no guidelines to support gentamicin prophylaxis and only a very low risk of bacteraemia associated with IDC insertion/removal in patients with established bacteriuria. Consensus was reached with the surgeons to discontinue this practice. Subsequent prospective data collection was commenced to determine effectiveness, with weekly feedback to the Department Head of Orthopaedics. RESULTS Data from 137 operations pre-intervention (6 months) were compared with 205 operations post-intervention (12 months). The median patient age was 72 years in both groups. Following the intervention, reductions in gentamicin use were demonstrated for IDC insertion (59/137 (42%) to 4/205 (2%), P < 0.01) and removal (39/137 (28%) to 6/205 (3%), P < 0.01). No gentamicin use was observed during the final 40 weeks of the post-intervention period. There were no significant differences between the groups for pre-operative bacteriuria, surgical site infections or acute kidney injury. CONCLUSION A collaborative approach using quality improvement methodology can lead to an evidence-based reappraisal of established practice. Regular rolling audits and timely feedback were useful in sustaining change.
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Affiliation(s)
- Stuart E Bond
- Department of Pharmacy, Wollongong Hospital, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Craig S Boutlis
- Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Stuart G Jansen
- Department of Orthopaedic Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Spiros Miyakis
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.,Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia
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Pannell WC, Banks K, Hahn J, Inaba K, Marecek GS. Antibiotic related acute kidney injury in patients treated for open fractures. Injury 2016; 47:653-7. [PMID: 26854072 DOI: 10.1016/j.injury.2016.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Antibiotic administration during the treatment of open fractures has been shown to reduce infection rates and is considered a critical step in the management of these injuries. The purpose of this study was to determine if aminoglycoside administration during the treatment of open fractures leads to acute kidney injury. METHODS Patient records at a level I trauma centre were reviewed for adult patients who presented in 2014 with open fractures were screened for inclusion. Patients were excluded with fractures of the phalanges, metatarsals, and metacarpals, with isolated traumatic arthrotomies, or pre-existing renal dysfunction. Charts were reviewed for patient age, gender, race, past medical history, medication history, injury severity score, intravenous dye studies and fracture type. Patients were divided into those given cefazolin (Group A) and cefazolin with gentamicin (Group B). Laboratory values were used to determine which patients developed kidney dysfunction as measured using the RIFLE criteria. Wilcoxon-Mann-Whitney test and Chi-square were used to compare interval and categorical variables, respectively. Significance was set at P<0.05. RESULTS One-hundred and fifty-nine patients met inclusion criteria. Forty-one (25%) patients were given cefazolin alone and 113 (68%) patients were given cefazolin with gentamicin. Ten (18%) patients with Gustilo-Anderson type III fractures were given cefazolin alone and 67 (67%) patients with types I or II fractures were given a cefazolin with gentamicin. Baseline characteristics and risk factors for renal dysfunction did not vary between groups. Two (4.8%) patients in Group A and 5 (4%) patients in Group B developed acute kidney injury (P=0.599). CONCLUSIONS Gentamicin use during the treatment of open fractures does not lead to increased rates of renal dysfunction when used in patients with normal baseline renal function.
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Affiliation(s)
- William C Pannell
- Department of Orthopaedic Surgery, USC, Los Angeles, CA, United States.
| | - Kian Banks
- Keck School of Medicine at USC, Los Angeles, CA, United States
| | - Joseph Hahn
- Department of Orthopaedic Surgery, USC, Los Angeles, CA, United States
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, USC, Los Angeles, CA, United States
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Giri VP, Giri OP, Bajracharya S, Khan FA, Sinha SP, Kanodia S, Bansal C. Risk of Acute Kidney Injury with Amikacin versus Gentamycin both in Combination with Metronidazole for Surgical Prophylaxis. J Clin Diagn Res 2016; 10:FC09-12. [PMID: 26894084 PMCID: PMC4740612 DOI: 10.7860/jcdr/2016/15621.7099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/27/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Surgical site infection is one of the most important complication of surgery. It increases the mortality and morbidity. In order to decrease the incidence of surgical site infections perioperative antimicrobial prophylaxis has been recommended in certain types of clean and clean contaminated surgeries. Aminoglycosides are indicated as surgical prophylaxis for prevention of surgical site infection in patients with B-lactam allergy. AIM The present study was carried out to study and compare the renal safety profile of single high dose gentamycin and amikacin as surgical prophylactic antibiotic. MATERIALS AND METHODS Prospective and randomized study was carried out on 100 patients for over one year period in a tertiary care teaching hospital of western Uttar Pradesh, India. Patients in amikacin group received amikacin 15 mg/kg + metronidazole 500 mg intravenously single dose and those in the gentamycin group had gentamycin 5 mg/kg + metronidazole 500 mg intravenously single dose, one hour prior to incision. RESULT A total of 16% patients of amikacin group and 24% patients of gentamycin group developed acute kidney injury within one week of drug administration. The rise in serum creatinine was temporary as all patients had normal serum creatinine level at one month follow up. CONCLUSION Aminoglycoside intravenous single high dose is not safe as surgical prophylaxis.
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Affiliation(s)
- Vishal Prakash Giri
- Assistant Professor, Department of Pharmacology, TMMC & RC, Moradabad, India
| | - Om Prakash Giri
- Professor and Head, Department of Pulmonary Medicine, DMCH, Darbhanga, India
| | - Subarna Bajracharya
- Post Graduate Student, Department of Pharmacology, TMMC & RC, Moradabad, India
| | - Farhan Ahmad Khan
- Associate Professor, Department of Pharmacology, TMMC & RC, Moradabad, India
| | | | - Shubhra Kanodia
- Post Graduate Student, Department of Oral Medicine and Radiology, TMDC & RC, Moradabad, India
| | - Chitrak Bansal
- Post Graduate Student, Department of Pharmacology, TMMC & RC, Moradabad, India
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Nielsen DV, Fedosova M, Hjortdal V, Jakobsen CJ. Is single-dose prophylactic gentamicin associated with acute kidney injury in patients undergoing cardiac surgery? A matched-pair analysis. J Thorac Cardiovasc Surg 2014; 148:1634-9. [DOI: 10.1016/j.jtcvs.2014.05.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/16/2014] [Accepted: 05/22/2014] [Indexed: 11/26/2022]
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Antibiotic-associated complications following lower limb arthroplasty: a comparison of two prophylactic regimes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:539-43. [DOI: 10.1007/s00590-013-1348-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 10/18/2013] [Indexed: 01/03/2023]
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Martin E, Paniker J. Is prophylactic Gentamicin associated with acute kidney injury in patients undergoing surgery for fractured neck of femur? Injury 2013; 44:1664. [PMID: 23809608 DOI: 10.1016/j.injury.2013.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 04/28/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Ellen Martin
- Department of Orthopaedic Surgery, Chester NHS Foundation Trust, Liverpool Road, Chester, UK.
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