Vol.73 No.6 November 2025
Identification of the cutoff value of the blood gentamicin concentration for predicting the risk of development of acute kidney injury during continuous local antibiotics perfusion therapy
1)Department of Pharmacy, Gifu Prefectural General Medical Center
2)College of Pharmacy, Kinjo Gakuin University, 2-1723 Omori, Moriyama-ku, Nagoya, Aichi Prefecture, Japan
Abstract
Use of continuous local antibiotics perfusion (CLAP) therapy for the control of postoperative bone and soft tissue infections has become widespread in clinical practice. Gentamicin (GM) is a frequently used antibiotic in CLAP therapy. Therapeutic drug monitoring is required to prevent the development of acute kidney injury (AKI) when administering GM for CLAP therapy. However, there are no published reports until date that have documented a clear association of the blood concentrations of GM during CLAP therapy with the risk of development of AKI. Therefore, we investigated the cutoff value of the blood GM concentrations (blood GM concentration after establishment of a stable state of perfusion after the start of CLAP therapy) for predicting the risk of development of AKI.
For this study, we included the data of 55 patients who did not have any evidence of AKI prior to the initiation of CLAP therapy among the 70 who had received CLAP therapy during the investigation period. Of the 55 patients, five patients, with maintenance blood GM concentrations in the range of 2.5-3.3 μg/mL, developed AKI. A significant difference in the incidence of AKI was observed between the groups with maintenance blood GM concentrations of <2 μg/mL (0%) and ≥2 μg/mL groups (26.3%) (P=0.003), based on the determined cutoff value of the maintenance blood GM concentration for predicting the risk of development of AKI. However, there were no differences in the patient background characteristics, including the age or renal function status prior to the start of CLAP therapy, between the two groups. Of the five patients who developed AKI, improvement of the serum creatinine concentration was recognized in three patients after the completion of CLAP therapy. These results indicate that the maintenance blood GM concentration during CLAP therapy using GM should be maintained under 2 μg/mL to prevent AKI.
We suggest that in the interest of ensuring safety, the maintenance blood GM concentration be monitored during CLAP therapy using GM.
Key word
gentamicin, continuous local antibiotics perfusion, acute kidney injury, blood concentration
Received
February 12, 2025
Accepted
June 26, 2025
Jpn. J. Chemother. 73 (6): 572-579, 2025
