NEW ORLEANS — Patients who receive a low dose of gentamicin for type 3 open fracture prophylaxis showed kidney dysfunction and other symptoms associated with kidney dysfunction, according to data presented here.
“Direct and sole causation of kidney dysfunction by gentamicin can’t be inferred from this data. But, identifying risk factors for kidney dysfunction in the use of a known nephrotoxic agent, like gentamicin, is important to consider. We know gentamicin does have excellent gram-negative coverage, but the benefit of this treatment versus the risk of nephrotoxicity should be considered on a case-by-case basis,” Clay A. Spitler, MD, said at the American Academy of Orthopaedic Surgeons Annual Meeting.
Spitler and colleagues performed a retrospective database review of all open long-bone fractures in adult patients during a 4.9-year period to identify patients who received gentamicin for open fracture antibiotic prophylaxis. They identified 347 patients who received gentamicin for open fracture prophylaxis and had creatinine levels drawn upon admission and through the end of gentamicin therapy. Patients received 2-g cefazolin every 8 hours and 80-mg gentamicin twice daily from time of arrival in the ER until 48 hours after coverage of wounds. Patients were placed in groups based on kidney function according to RIFLE criteria, with group 1 having normal kidney function and group 2 having kidney risk, injury or kidney failure.
Spitler and colleagues found 93 patients (overall incidence of 26.8%) had kidney dysfunction or other factors of kidney dysfunction. Patient factors associated with kidney dysfunction were female gender, higher weight and lower baseline creatinine. Patients in group 2 had a higher Injury Severity Score and were more likely to require ICU admission. Group 2 patients were more likely to require multiple debridement, have undergone CT-contrast imaging and had longer duration of gentamicin than patients in group 1. – by Kristine Houck, MA, ELS
Spitler CA, et al. Paper #39. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 6-10, 2018; New Orleans.
Disclosure: Spitler reports he is a board or committee member for the American Academy of Orthopaedic Surgeons and the Orthopaedic Trauma Association; is a paid presenter or speaker for AO Trauma; receives research support from Synthes; is on the editorial or governing board for the Journal of Bone and Joint Surgery.