The Association of Aminoglycoside Plasma Levels With Mortality in Patients With Gram-Negative Bacteremia

J Infect Dis. 1984 Mar;149(3):443-8. doi: 10.1093/infdis/149.3.443.

Abstract

To determine the association of aminoglycoside levels with mortality from gram-negative bacteremia, we analyzed the case reports of patients from four prospective, randomized, and controlled clinical trials of gentamicin, tobramycin, and amikacin. Twelve (13.5%) of 89 patients died. One (2.4%) death occurred in 41 patients with early (1-hr postinfusion) peak concentrations of greater than 5 micrograms/ml of gentamicin and tobramycin and of greater than 20 micrograms of amikacin/ml; nine deaths (20.9%) occurred in 43 patients with lower concentrations. Five (8.3%) deaths occurred in 60 patients with mean peak concentrations for the entire course of therapy of greater than 5 micrograms/ml of gentamicin and tobramycin and of greater than 20 micrograms of amikacin/ml; five (20.8%) deaths occurred in 24 patients with lower concentrations. Stepwise discriminant analysis showed that therapeutic early peak concentration was a significant factor in the presence of three other factors: severity of underlying illness, peak temperature, and initial leukocyte count. The results suggest the importance of achieving adequate early aminoglycoside levels in patients with gram-negative bacteremia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Amikacin / adverse effects
  • Amikacin / blood*
  • Body Temperature
  • Gentamicins / adverse effects
  • Gentamicins / blood*
  • Gram-Negative Bacteria
  • Humans
  • Kanamycin / analogs & derivatives*
  • Kidney Diseases / chemically induced
  • Leukocyte Count
  • Middle Aged
  • Proteus Infections / mortality
  • Sepsis / blood
  • Sepsis / drug therapy
  • Sepsis / mortality*
  • Statistics as Topic
  • Tobramycin / adverse effects
  • Tobramycin / blood*

Substances

  • Gentamicins
  • Kanamycin
  • Amikacin
  • Tobramycin