Initial Low‐Dose Gentamicin for Staphylococcus aureus Bacteremia and Endocarditis Is Nephrotoxic
Abstract
Background.The safety of adding initial low-dose gentamicin to antistaphylococcal penicillins or vancomycin for treatment of suspected Staphylococcus aureus native valve endocarditis is unknown. This study evaluated the association between this practice and nephrotoxicity. Methods.We performed a prospective cohort study of safety data from a randomized, controlled trial of therapy for S. aureus bacteremia and native valve infective endocarditis involving 236 patients from 44 hospitals in 4 countries. Patients either received standard therapy (antistaphylococcal penicillin or vancomycin) plus initial low-dose gentamicin (n=116) or received daptomycin monotherapy (n=120). We measured renal adverse events and clinically significant decreased creatinine clearance in patients (1) in the original randomized study arms and (2) who received any initial low-dose gentamicin either, as a study medication or <2 days before enrollment. Results.Renal adverse events occurred in 8 (7%) of 120 daptomycin recipients, 10 (19%) of 53 vancomycin recipients, and 11 (17%) of 63 antistaphylococcal penicillin recipients. Decreased creatinine clearance occurred in 9 (8%) of 113 of evaluable daptomycin recipients, 10 (22%) of 46 vancomycin recipients, and 16 (25%) of 63 antistaphylococcal penicillin recipients. An additional 21 patients received initial low-dose gentamicin <2 days before study enrollment. A total of 22% of patients who received initial low-dose gentamicin versus 8% of patients who did not receive initial low-dose gentamicin experienced decreased creatinine clearance (P=.005). Independent predictors of a clinically significant decrease in creatinine clearance were age ⩾65 years and receipt of any initial low-dose gentamicin. Conclusions.Initial low-dose gentamicin as part of therapy for S. aureus bacteremia and native valve infective endocarditis is nephrotoxic and should not be used routinely, given the minimal existing data supporting its benefit.
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In a post hoc analysis of the landmark clinical trial, the addition of low-dose short-course gentamicin in one arm was significantly associated with renal toxicity, which occurred early and often, and the clinical association between gentamicin dose and duration was minimal.
“Of note, in a post hoc analysis of this landmark clinical trial, 149 the addition of even such low-dose, short-course gentamicin in 1 arm of the study was significantly associated with renal toxicity, which occurred early and often, and the clinical association between gentamicin dose and duration was minimal.”
The risk of clinically significant nephrotoxicity with even short courses of adjunctive low-dose gentamicin for S aureus bacteremia and right-sided infective endocarditis can be substantial.
“As noted above, 149 the risk of clinically significant nephrotoxicity with even short courses of adjunctive low-dose gentamicin for S aureus bacteremia and right-sided IE can be substantial.”
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References 33 · Cited by 309
Research works printed but not linked: 3
- [1]1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: di- agnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheu- matic Fever, Endocarditis, and Kawasaki Disease, Council on Cardio- vascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association. Circulation 2005; 111:e394-434.
- [17]17. Wilhelm MP, Estes L. Symposium on antimicrobial agents, part XII: vancomycin. Mayo Clin Proc 1999; 74:928-35.
- [18]18. Wright AJ. The penicillins. Mayo Clin Proc 1999; 74:290-307.
- Authors
- Cosgrove, S. E., Vigliani, G. A., Campion, M., Fowler, Jr., Abrutyn, E., Corey, G. R., Levine, D. P., Rupp, M. E., Chambers, H. F., Karchmer, A. W., & Boucher, H. W.
- Affiliations
- Johns Hopkins University (US)
- Harvard University (US)
- Duke University (US)
- Wayne State University (US)
- University of Nebraska Medical Center (US)
- Beth Israel Deaconess Medical Center (US)
- Tufts University (US)
- Corresponding author
- Cosgrove, Sara E.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-03-15
- Volume
- 48
- Issue
- 6
- Pages
- 713-721
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2129266432
- Cited by
- 309
- References
- 33
- Citations by year
- 2026: 12 · 2025: 9 · 2024: 13 · 2023: 11 · 2022: 14 · 2021: 7 · 2020: 18 · 2019: 15 · 2018: 14 · 2017: 19 · 2016: 21 · 2015: 24 · 2014: 15 · 2013: 22 · 2012: 16
- FWCI
- 21.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Astellas Pharma
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
- Keywords
- gentamicin, nephrotoxicity, Staphylococcus aureus, bacteremia, infective endocarditis, native valve endocarditis, daptomycin, vancomycin, renal adverse effects, creatinine clearance, drug safety
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Creatinine, Drug Therapy, Combination, Endocarditis, Bacterial, Female, Gentamicins, Humans, Kidney, Male, Metabolic Clearance Rate, Middle Aged, Penicillins, Prospective Studies, Staphylococcal Infections, Staphylococcus aureus, Vancomycin, Cohort Studies, Bacteremia, Daptomycin, Young Adult
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