Risk of AKI with Gentamicin as Surgical Prophylaxis
Risk of AKI with Gentamicin as Surgical Prophylaxis
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DOI：
10.1681/asn.2014010035
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发表时间：
2014-11-01
影响因子：
13.6
通讯作者：
Donnan, Peter T.
中科院分区：
文献类型：
--
作者：
Bell, Samira;Davey, Peter;Donnan, Peter T.
2009年，苏格兰政府发布了一个目标，在两年内将艰难梭菌感染减少30%。因此，苏格兰医院在外科抗生素预防中从头孢菌素改为庆大霉素。本研究检查了政策变更前后的术后阿基发生率。研究人群包括2006年10月1日至2010年9月30日在苏格兰泰赛德地区接受手术（骨科、泌尿科、血管、胃肠道和妇科）并预防抗生素的12，482名成人。术后阿基由肾脏疾病改善全球结局标准定义。研究设计是一个中断的时间序列与分段回归分析。在骨科患者中，从头孢呋辛变更为氟氯西林（2剂1 g）和单次庆大霉素（4 mg/kg）的政策与阿基增加94%相关（P=0.04; 95%置信区间，93.8%至94.3%）。大多数预防性庆大霉素治疗后发生阿基的患者为1期阿基，但有些患者发生持续性2期或3期阿基。抗生素政策的改变与其他组中阿基的显著增加无关。然而，无论抗生素治疗方案如何，血管手术后阿基的发生率都很高（24%），并且在胃肠道手术后稳步增加。由于缺乏肌酐检测，仅在52%的泌尿科患者和47%的妇科患者中可以确定发生率。这些结果表明，庆大霉素应避免骨科患者在围手术期。我们的研究结果还引起了对术后阿基患病率增加和无法持续测量术后肾功能的担忧。
In 2009, the Scottish government issued a target to reduce Clostridium difficile infection by 30% in 2 years. Consequently, Scottish hospitals changed from cephalosporins to gentamicin for surgical antibiotic prophylaxis. This study examined rates of postoperative AKI before and after this policy change. The study population comprised 12,482 adults undergoing surgery (orthopedic, urology, vascular, gastrointestinal, and gynecology) with antibiotic prophylaxis between October 1, 2006, and September 30, 2010 in the Tayside region of Scotland. Postoperative AKI was defined by the Kidney Disease Improving Global Outcomes criteria. The study design was an interrupted time series with segmented regression analysis. In orthopedic patients, change in policy from cefuroxime to flucloxacillin (two doses of 1 g) and single-dose gentamicin (4 mg/kg) was associated with a 94% increase in AKI (P=0.04; 95% confidence interval, 93.8% to 94.3%). Most patients who developed AKI after prophylactic gentamicin had stage 1 AKI, but some patients developed persistent stage 2 or stage 3 AKI. The antibiotic policy change was not associated with a significant increase in AKI in the other groups. Regardless of antibiotic regimen, however, rates of AKI were high (24%) after vascular surgery, and increased steadily after gastrointestinal surgery. Rates could only be ascertained in 52% of urology patients and 47% of gynecology patients because of a lack of creatinine testing. These results suggest that gentamicin should be avoided in orthopedic patients in the perioperative period. Our findings also raise concerns about the increasing prevalence of postoperative AKI and failures to consistently measure postoperative renal function.