No increased risk of acute kidney injury after a single dose of gentamicin in patients with sepsis

Background Aminoglycosides are frequently used in the empirical treatment of sepsis. However, aminoglycosides may induce acute kidney injury (AKI). Data is lacking on the renal safety of a single dose of aminoglycosides in septic patients visiting the emergency department (ED). Aim To investigate the incidence of AKI in septic patients after a single dose of gentamicin (5mg/kg) and to evaluate possible risk factors. Methods This study retrospectively followed patients, aged18 years, visiting the ED and fulfilling sepsis criteria for 1 year. Two groups were analysed: septic patients receiving gentamicin in combination with beta-lactam antibiotics and a control group with pneumosepsis patients only without gentamicin. Renal function was determined prior to admission, at presentation and during the following 2 weeks. AKI was defined according to the RIFLE criteria. Results In total, 302 patients were included, 179 in the gentamicin and 123 in the control group. Mean gentamicin dose was 4.7 +/- 0.7mg/kg. At admission, 26.8% of the gentamicin and 16.3% of the control group had AKI. After admission, AKI occurred in 6.7% of the gentamicin and in 3.3% of the control group (p=0.30). Occurrence of AKI was not associated with gentamicin administration, but with septic shock (31.2% in patients with AKI vs 9.8% without AKI after admission, p=0.02). Conclusion This study showed no increased risk of AKI after a single dose of gentamicin to patients with sepsis in the ED, suggesting that a single dose of gentamicin can, with regard to renal function, be safely administered to septic patients.