RESUMO
OBJECTIVES: To determine the effect of a single dose of gentamicin on the incidence and persistence of acute kidney injury (AKI) in patients with sepsis in the emergency department (ED). METHODS: We retrospectively studied patients with sepsis in the ED in three hospitals. Local antibiotic guidelines recommended a single dose of gentamicin as part of empirical therapy in selected patients in one hospital, whereas the other two hospitals did not. Multivariate analysis was used to evaluate the effect of gentamicin and other potential risk factors on the incidence and persistence of AKI after admission. AKI was defined according to the KDIGO (Kidney Disease Improving Global Outcomes) criteria. RESULTS: Of 1573 patients, 571 (32.9%) received a single dose of gentamicin. At admission, 181 (31.7%) of 571 of the gentamicin-treated and 228 (22.8%) of 1002 of the non-gentamicin-treated patients had AKI (p < 0.001). After admission, AKI occurred in 64 (12.0%) of 571 patients who received gentamicin and in 82 (8.9%) of 1002 people in the control group (p 0.06). Multivariate analysis showed that shock (odds ratio (OR), 2.72; 95% CI, 1.31-5.67), diabetes mellitus (OR, 1.49; 95% CI, 1.001-2.23) and higher baseline (i.e. before admission) serum creatinine levels (OR, 1.007; 95% CI, 1.005-1.009) were associated with the development of AKI after admission, but not receipt of gentamicin (OR, 1.29; 95% CI, 0.89-1.86). Persistent AKI was rare in both the group that received gentamicin (16/260, 6.2%) and the group that did not (15/454, 3.3%, p 0.09). CONCLUSIONS: With regard to renal function, a single dose of gentamicin in patients with sepsis in the ED is safe. The development of AKI after admission was associated with shock, diabetes mellitus and higher baseline creatinine level.
RESUMO
BACKGROUND: Staphylococcus aureus bacteraemia is associated with a high mortality rate. Previously it has been shown that consultation by an internist-infectious diseases specialist (IDS) improves the outcome of patients. In this study, we evaluated the differences in management and outcome between patients with, and those without IDS consultation. METHODS: All adult patients with a positive blood culture for S. aureus from January 2010 to December 2013 were retrospectively identified with the electronic registration system of our Laboratory for Medical Microbiology. Clinical and microbiological characteristics were retrieved from the electronic patient files, as well as information on bedside consultation by an IDS. RESULTS: A total of 234 patients with S. aureus bacteraemia were included in the study, of whom 77.8% were consulted by an IDS. Management of patients with IDS consultation was more often according to guidelines than was the case without consultation by an IDS; follow up blood cultures were taken more often (97.8% vs. 80.8%, p < 0.001), patients received echocardiography more often (70.9% vs. 50.0%, p = 0.007), and they were more often treated adequately (86.6% vs. 59.2%, p < 0.001). The detection rate of complications in the IDS group was higher (59.3% vs. 32.7%, p = 0.001) and 30-day mortality rate was lower (12.1% vs. 23.1%, p = 0.04). This was confirmed by multivariate analysis. CONCLUSION: In patients with a S. aureus bacteraemia, bedside consultation by an IDS results in better adherence to diagnostic and treatment guidelines, with higher detection of complications and a higher survival rate.