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. 2017 Mar;5(5):100.
doi: 10.21037/atm.2017.03.06.

Surgical prophylaxis with gentamicin and acute kidney injury: a systematic review and meta-analysis

Weeraporn Srisung  1 , Jirapat Teerakanok  2 , Pakpoom Tantrachoti  2 , Amputch Karukote  3 , Kenneth Nugent  2
Affiliations

Surgical prophylaxis with gentamicin and acute kidney injury: a systematic review and meta-analysis

Weeraporn Srisung et al. Ann Transl Med. 2017 Mar.

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.

Keywords: Acute kidney injury (AKI); antibiotic prophylaxis; gentamicin; surgical prophylaxis.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Demonstrates the flow diagram of the study selection process.
Figure 2
Figure 2
Demonstrates the analysis with all studies included, regardless of surgery type.
Figure 3
Figure 3
Demonstrates the subgroup analysis according to surgery type.
Figure 4
Figure 4
Illustrates the funnel plot of all studies included in this meta-analysis. RR, risk ratio.
Figure 5
Figure 5
Demonstrates the result of risk of bias assessment of each study.
Figure 6
Figure 6
Demonstrates the pooled risk of bias assessment of studies included in this meta-analysis.
See this image and copyright information in PMC

References

    1. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 Suppl 2:S66-88. 10.1017/S0899823X00193869 - DOI - PubMed
    1. Luo S, Lai Y, Liu C, et al. Prophylactic use of gentamicin/flucloxacillin versus cefuroxime in surgery: a meta analysis of clinical studies. International journal of clinical and experimental medicine 2015;8:17856-67. - PMC - PubMed
    1. Blondeau JM. What have we learned about antimicrobial use and the risks for Clostridium difficile-associated diarrhoea? J Antimicrob Chemother 2009;63:238-42. 10.1093/jac/dkn477 - DOI - PubMed
    1. Bailey O, Torkington MS, Anthony I, et al. Antibiotic-related acute kidney injury in patients undergoing elective joint replacement. Bone Joint J 2014;96B:395-8. 10.1302/0301-620X.96B3.32745 - DOI - PubMed
    1. Selby NM, Shaw S, Woodier N, et al. Gentamicin-associated acute kidney injury. QJM 2009;102:873-80. 10.1093/qjmed/hcp143 - DOI - PubMed

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