Low-dose Gentamicin for Uncomplicated Enterococcus faecalis Bacteremia May be Nephrotoxic in Children

Sarai Little Ibrahim, Long Zhang, Tammy McLoughlin Brady, Alice J. Hsu, Sara Cosgrove, Pranita Tamma

Research output: Contribution to journalArticle

Abstract

Background.Uncertainty exists regarding the role of synergistic gentamicin for uncomplicated Enterococcus faecalis bacteremia in children. Methods.We conducted a retrospective, observational study comparing clinical outcomes of children with E. faecalis bacteremia without endocarditis receiving ampicillin monotherapy with those receiving ampicillin along with low-dose gentamicin therapy. To account for nonrandom assignment of combination therapy, propensity score weighting was combined with multivariable regression to estimate the effect of combination therapy on duration of bacteremia, bacteremic relapse, and acute kidney injury (AKI). Results.One hundred sixty-three (52%) patients received ampicillin with low-dose gentamicin, and 150 (48%) patients received ampicillin monotherapy. Incorporating propensity-score weighting with additional adjustment for source control measures, patients receiving combination therapy experienced bacterial clearance 10 hours faster than children receiving ampicillin monotherapy (adjusted mean difference 0.42; confidence interval (CI),. 02 to. 82; P =. 04). Bacteremic relapse was similar between the two groups (17% vs 18%); adjusted hazards ratio (aHR) 1.12; 95% CI,. 65 to 1.92. Children receiving low-dose gentamicin had approximately twice the risk of developing AKI compared to children not receiving this agent, adjusting for the receipt of additional nephrotoxins (aHR 1.94; 95% CI, 1.48-2.97). Conclusions.Our study suggests that for children with uncomplicated E. faecalis bacteremia, the addition of low-dose gentamicin may decrease the time to bacterial clearance by 10 hours but without any impact on recurrent bacteremia. However, with this potential benefit comes the increased likelihood of AKI. Low-dose gentamicin for the treatment of uncomplicated enterococcal bacteremia may pose harm to children with limited benefit.

Original languageEnglish (US)
Pages (from-to)1119-1124
Number of pages6
JournalClinical Infectious Diseases
Volume61
Issue number7
DOIs
StatePublished - Oct 1 2015

Fingerprint

Enterococcus faecalis
Bacteremia
Gentamicins
Ampicillin
Acute Kidney Injury
Propensity Score
Confidence Intervals
Therapeutics
Recurrence
Endocarditis
Uncertainty
Observational Studies
Retrospective Studies

Keywords

  • aminoglycosides
  • Enterococcus faecalis
  • gentamicin
  • pediatrics
  • synergy

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Low-dose Gentamicin for Uncomplicated Enterococcus faecalis Bacteremia May be Nephrotoxic in Children. / Ibrahim, Sarai Little; Zhang, Long; Brady, Tammy McLoughlin; Hsu, Alice J.; Cosgrove, Sara; Tamma, Pranita.

In: Clinical Infectious Diseases, Vol. 61, No. 7, 01.10.2015, p. 1119-1124.

Research output: Contribution to journalArticle

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abstract = "Background.Uncertainty exists regarding the role of synergistic gentamicin for uncomplicated Enterococcus faecalis bacteremia in children. Methods.We conducted a retrospective, observational study comparing clinical outcomes of children with E. faecalis bacteremia without endocarditis receiving ampicillin monotherapy with those receiving ampicillin along with low-dose gentamicin therapy. To account for nonrandom assignment of combination therapy, propensity score weighting was combined with multivariable regression to estimate the effect of combination therapy on duration of bacteremia, bacteremic relapse, and acute kidney injury (AKI). Results.One hundred sixty-three (52{\%}) patients received ampicillin with low-dose gentamicin, and 150 (48{\%}) patients received ampicillin monotherapy. Incorporating propensity-score weighting with additional adjustment for source control measures, patients receiving combination therapy experienced bacterial clearance 10 hours faster than children receiving ampicillin monotherapy (adjusted mean difference 0.42; confidence interval (CI),. 02 to. 82; P =. 04). Bacteremic relapse was similar between the two groups (17{\%} vs 18{\%}); adjusted hazards ratio (aHR) 1.12; 95{\%} CI,. 65 to 1.92. Children receiving low-dose gentamicin had approximately twice the risk of developing AKI compared to children not receiving this agent, adjusting for the receipt of additional nephrotoxins (aHR 1.94; 95{\%} CI, 1.48-2.97). Conclusions.Our study suggests that for children with uncomplicated E. faecalis bacteremia, the addition of low-dose gentamicin may decrease the time to bacterial clearance by 10 hours but without any impact on recurrent bacteremia. However, with this potential benefit comes the increased likelihood of AKI. Low-dose gentamicin for the treatment of uncomplicated enterococcal bacteremia may pose harm to children with limited benefit.",
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