The Role of Monitoring Gentamicin Levels in Patients with Gram-Negative Peritoneal Dialysis-Associated Peritonitis
| Autor: | Carmel M. Hawley, Sunil V. Badve, David W. Johnson, Wen Tang, Yeoungjee Cho |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Peritonitis Peritoneal dialysis Cohort Studies Gentamicin levels Internal medicine Gram-Negative Bacteria medicine Humans In patient Prospective Studies Intensive care medicine Aged medicine.diagnostic_test business.industry Original Articles General Medicine Middle Aged medicine.disease Antimicrobial Anti-Bacterial Agents Treatment Outcome Nephrology Therapeutic drug monitoring Kidney Failure Chronic Female Gentamicin Drug Monitoring Gentamicins Gram-Negative Bacterial Infections business Peritoneal Dialysis medicine.drug |
| Zdroj: | Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis. 34:219-226 |
| ISSN: | 1718-4304 0896-8608 |
| Popis: | Background There is limited available evidence regarding the role of monitoring serum gentamicin concentrations in peritoneal dialysis (PD) patients receiving this antimicrobial agent in gram-negative PD-associated peritonitis. Methods Using data collected in all patients receiving PD at a single center who experienced a gram-negative peritonitis episode between 1 January 2005 and 31 December 2011, we investigated the relationship between measured serum gentamicin levels on day 2 following initial empiric antibiotic therapy and subsequent clinical outcomes of confirmed gram-negative peritonitis. Results Serum gentamicin levels were performed on day 2 in 51 (77%) of 66 first gram-negative peritonitis episodes. Average serum gentamicin levels on day 2 were 1.83 ± 0.84 mg/L with levels exceeding 2 mg/L in 22 (43%) cases. The overall cure rate was 64%. No cases of ototoxicity were observed. Day-2 gentamicin levels were not significantly different between patients who did and did not have a complication or cure. Using multivariable logistic regression analysis, failure to cure peritonitis was not associated with either day-2 gentamicin level (adjusted odds ratio (OR) 0.96, 95% confidence interval (CI) 0.25 – 3.73) or continuation of gentamicin therapy beyond day 2 (OR 0.28, 0.02 – 3.56). The only exception was polymicrobial peritonitis, where day-2 gentamicin levels were significantly higher in episodes that were cured (2.06 ± 0.41 vs 1.29 ± 0.71, p = 0.01). In 17 (26%) patients receiving extended gentamicin therapy, day-5 gentamicin levels were not significantly related to peritonitis cure. Conclusion Day-2 gentamicin levels did not predict gentamicin-related harm or efficacy during short-course gentamicin therapy for gram-negative PD-related peritonitis, except in cases of polymicrobial peritonitis, where higher levels were associated with cure. |
| Databáze: | OpenAIRE |
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