Is gentamicin safe and effective for severe community-acquired pneumonia? An 8-year retrospective cohort study

被引:9
作者
Brereton, Christopher J. [1 ,2 ]
Lennon, Daniel [1 ]
Browning, Sarah [1 ]
Dunn, Emily [1 ]
Ferguson, John K. [1 ,2 ,3 ]
Davis, Joshua S. [1 ,2 ,4 ]
机构
[1] John Hunter Hosp, Div Med, Lookout Rd, Newcastle, NSW 2305, Australia
[2] Univ Newcastle, Sch Med & Publ Hlth, Newcastle, NSW 2308, Australia
[3] Pathol North, Newcastle, NSW 2305, Australia
[4] Menzies Sch Hlth Res, Global & Trop Hlth Div, Darwin, NT 0811, Australia
基金
英国医学研究理事会;
关键词
Gentamicin; Aminoglycoside; Community-acquired pneumonia; Bacterial pneumonia; Critical care; Gram-negative; GRAM-NEGATIVE BACTERIA; RISK STRATIFICATION; AUSTRALIA; ETIOLOGY; ADMISSION;
D O I
10.1016/j.ijantimicag.2018.01.018
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Gram-negative bacilli are the causative organisms in a significant proportion of patients with severe community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU). Clinical guidelines recommend broad-spectrum antimicrobials for empirical treatment despite alarming global trends in antimicrobial resistance. In this study, we aimed to assess the safety and efficacy of gentamicin, an aminoglycoside with potent bactericidal activity, for empirical Gram-negative coverage of severe CAP in patients admitted to the ICU. A retrospective cohort study was performed at a university teaching hospital where the severe CAP guideline recommends penicillin, azithromycin and gentamicin as empirical cover. Ceftriaxone plus azithromycin is used as an alternative. Adults with radiologically-confirmed severe CAP were included, comparing those who received gentamicin in the first 72 h of admission with those who did not. Participants were identified using ICD-10 codes for bacterial pneumonia and data manually extracted from electronic medical records. Of 148 patients admitted with severe pneumonia, 117 were given at least one dose of gentamicin whereas the remaining 31 were not. The two groups were well matched in terms of demographics, co-morbidities and disease severity. There were no significant differences between the gentamicin and no-gentamicin groups in the incidence of acute kidney injury [60/117 (51%) vs. 16/31 (52%), respectively], hospital mortality [20/117 (17%) vs. 7/31 (23%)] and secondary outcomes including relapse and length of hospital stay. In conclusion, gentamicin is safe and has similar outcomes to alternative Gram-negative antimicrobial regimens for empirical coverage in severe CAP patients admitted to the ICU. Crown Copyright (c) 2018 Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:862 / 866
页数:5
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