Question: Does gentamicin use affect clinical outcomes and prognosis or just creatinine clearance?
Background: Impaired kidney function in patients with endocarditis predicts worse outcomes in both morbidity and mortality. Given that the aminoglycosides can be nephrotoxic, it has been debated whether physicians should abandon its use in these patients.
Study design: Prospective, observational, cohort study.
Setting: Two tertiary-care hospitals serving Copenhagen, Denmark, from 2002-2007.
Synopsis: The study identified 373 patients as having definite or probable infective endocarditis. (“Probable” meant patients underwent the same treatment for endocarditis as those with confirmed disease.) Gentamicin treatment decreased estimated creatinine clearance (CrCl) by 0.5% per day of treatment, with more significant decreases in CrCl associated with length of treatment and age. It did not increase the risk of in-hospital or post-discharge mortality, nor did it increase the need for dialysis. The mean duration of follow up was 562 days.
Bottom line: With appropriate monitoring, gentamicin is a reasonable treatment choice for patients with endocarditis when clinically indicated. Patient-centered outcomes are not negatively impacted by its use.
Citation: Buchholtz K, Larsen CT, Hassager C, Bruun NE. Severity of gentamicin’s nephrotoxic effect on patients with infective endocarditis: a prospective observational cohort study of 373 patients. Clin Infect Dis. 2009;48:65-71.
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—Reviewed by Michael Kedansky, MD, Victor Weaver, MD, Michael Goldman, MD, Lisa Gushwa, MD, Paul Hicks, MD, Barbara Eckstein, MD, and Christine Kneisel, MD, Department of Family and Community Medicine, University of Arizona