The role of monitoring gentamicin levels in patients with gram-negative peritoneal dialysis-associated peritonitis.

Abstract

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.

• Authors: Wen Tang, Yeoungjee Cho, Carmel M Hawley, Sunil V Badve, David W Johnson
• Journal: Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis (Perit Dial Int) 2014 Mar-Apr Vol. 34 Issue 2 Pg. 219-26 ISSN: 1718-4304 [Electronic] United States
• PMID: 24385334 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Gentamicins

Topics

• Adult
• Aged
• Anti-Bacterial Agents (pharmacokinetics)
• Cohort Studies
• Drug Monitoring
• Female
• Gentamicins (pharmacokinetics)
• Gram-Negative Bacteria (isolation & purification)
• Gram-Negative Bacterial Infections (metabolism, microbiology)
• Humans
• Kidney Failure, Chronic (therapy)
• Male
• Middle Aged
• Peritoneal Dialysis
• Peritonitis (metabolism, microbiology)
• Prospective Studies
• Treatment Outcome