JAC Advance Access published online on September 19, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm354
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Aminoglycoside treatment and mortality after bacteraemia in patients given appropriate empirical therapy: a Danish hospital-based cohort study
1 Anaesthesiology Sector North Jutland, 4th Department, Department of Intensive Care R, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark 2 Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark 3 Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark 4 Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, 03754 NH, USA
Received 28 March 2007; returned 3 May 2007; revised 18 August 2007; accepted 20 August 2007
* Corresponding author. Tel: +45-9932-3231; Fax: +45-9932-3216; E-mail: hcs{at}rn.dk
Objectives: The effectiveness and safety of aminoglycoside (AG)/ß-lactam combination therapy has been questioned in several meta-analyses. We examined the association between AG combination therapy and mortality and increase in serum creatinine in adult patients with bacteraemia given appropriate empirical antibiotic therapy.
Methods: Historical cohort study based on prospective registration of bacteraemias in a Danish hospital 1996–2002. AG + ß-lactam was the recommended empirical therapy for severe sepsis. We identified 1257 patients, of whom 969 received gentamicin or tobramycin (AG cohort); 288 patients not given AGs formed the non-AG cohort. We used Cox regression analysis to compare adjusted mortality rates; the association between AG therapy and increase in serum creatinine was analysed by logistic regression.
Results: The cumulative 30 day mortality in the AG cohort was 17.3% versus 18.1% in the non-AG cohort [adjusted mortality rate ratio (MRR) 1.02; 95% CI 0.74–1.39]. The adjusted 31–180 day MRR in the AG cohort was 1.72 (95% CI 1.15–2.55). AG therapy was associated with lower 30 day mortality in patients with an abdominal focus (adjusted 30 day MRR 0.52; 95% CI 0.24–1.10) or a urinary tract focus (adjusted 30 day MRR 0.48; 95% CI 0.22–1.08), but with a worse prognosis in patients with a respiratory tract focus (adjusted 30 day MRR 2.06; 95% CI 0.93–4.53). An increase in serum creatinine of 
45 µmol/L was observed similarly often in AG- and non-AG-treated patients [14.1% versus 12.4%, adjusted odds ratio 1.06; 95% CI 0.63–1.79].
Conclusions: Among patients with bacteraemia receiving appropriate empirical coverage, AG combination therapy was not associated with increased 30 day mortality and only a modest risk of raised serum creatinine. The longer-term prognosis should, however, be explored further.
Key Words: gentamicin , antibacterial agents , renal insufficiency , treatment outcome
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