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

Tang, Wen, Cho, Yeoungjee, Hawley, Carmel M., Badve, Sunil V. and Johnson, David W. (2014) The role of monitoring gentamicin levels in patients with gram-negative peritoneal dialysis-associated peritonitis. Peritoneal Dialysis International, 34 2: 219-226. doi:10.3747/pdi.2012.00318

Author Tang, Wen
Cho, Yeoungjee
Hawley, Carmel M.
Badve, Sunil V.
Johnson, David W.
Title The role of monitoring gentamicin levels in patients with gram-negative peritoneal dialysis-associated peritonitis
Journal name Peritoneal Dialysis International   Check publisher's open access policy
ISSN 0896-8608
Publication date 2014-03-01
Sub-type Article (original research)
DOI 10.3747/pdi.2012.00318
Open Access Status DOI
Volume 34
Issue 2
Start page 219
End page 226
Total pages 8
Place of publication Milton, ON, Canada
Publisher Multimed Inc.
Language eng
Formatted 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.
Keyword Aminoglycosides
Peritoneal dialysis
Therapeutic drug monitoring
Kidney failure
Chronic outcomes
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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