In the Journals

Gentamicin for open fracture treatment may increase kidney injury risk

Clay Spitler headshot
Clay A. Spitler

Use of gentamicin as an antibiotic treatment for open fracture may increase the risk of kidney injury among women and patients who are overweight, according to recently published results.

Using risk, injury, failure, loss of kidney function and ESRD criteria, Clay A. Spitler, MD, and colleagues categorized 371 patients who received gentamicin for antibiotic treatment of an open fracture from January 2008 to December 2012 as either having normal (74.9%) or abnormal kidney function (25.1%). Main outcome measures included kidney function, injury and treatment characteristics, and patient information.

Results showed patients with lower baseline creatinine levels and higher injury severity scores had abnormal kidney function. Researchers noted patients with abnormal kidney function were also more likely to require ICU admission compared with patients who had normal kidney function. Independent associations with abnormal kidney function included female sex, higher weight, ICU admission and use of CT-contrasted imaging, according to results. Researchers found a sharp increase in abnormal kidney function incidence as age increased.

“We, as orthopedic trauma surgeons, need to be aware of the entire physiologic picture when treating patients with open fractures,” Spitler told Healio.com/Orthopedics. “We know that gentamicin can be nephrotoxic and we need to be aware that there are some patients with open fractures who are at risk of kidney injury. In these patients, we should avoid gentamicin in the treatment of their open fractures and use alternative antibiotics.”

Although many centers follow the recommendation of cephalosporin and gentamicin in type 3 open fractures, Spitler said large multicenter prospective trials are needed “to help guide us in determining the best antibiotic treatment for our patients with open fractures in the current era of antibiotic resistance.” – by Casey Tingle

 

Disclosures: The authors report no relevant financial disclosures.

Clay Spitler headshot
Clay A. Spitler

Use of gentamicin as an antibiotic treatment for open fracture may increase the risk of kidney injury among women and patients who are overweight, according to recently published results.

Using risk, injury, failure, loss of kidney function and ESRD criteria, Clay A. Spitler, MD, and colleagues categorized 371 patients who received gentamicin for antibiotic treatment of an open fracture from January 2008 to December 2012 as either having normal (74.9%) or abnormal kidney function (25.1%). Main outcome measures included kidney function, injury and treatment characteristics, and patient information.

Results showed patients with lower baseline creatinine levels and higher injury severity scores had abnormal kidney function. Researchers noted patients with abnormal kidney function were also more likely to require ICU admission compared with patients who had normal kidney function. Independent associations with abnormal kidney function included female sex, higher weight, ICU admission and use of CT-contrasted imaging, according to results. Researchers found a sharp increase in abnormal kidney function incidence as age increased.

“We, as orthopedic trauma surgeons, need to be aware of the entire physiologic picture when treating patients with open fractures,” Spitler told Healio.com/Orthopedics. “We know that gentamicin can be nephrotoxic and we need to be aware that there are some patients with open fractures who are at risk of kidney injury. In these patients, we should avoid gentamicin in the treatment of their open fractures and use alternative antibiotics.”

Although many centers follow the recommendation of cephalosporin and gentamicin in type 3 open fractures, Spitler said large multicenter prospective trials are needed “to help guide us in determining the best antibiotic treatment for our patients with open fractures in the current era of antibiotic resistance.” – by Casey Tingle

 

Disclosures: The authors report no relevant financial disclosures.