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Antimicrobial Agents and Chemotherapy, July 2009, p. 2887-2891, Vol. 53, No. 7
0066-4804/09/$08.00+0 doi:10.1128/AAC.01430-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Prevalence and Risk Factors for Aminoglycoside Nephrotoxicity in Intensive Care Units 
João F. P. Oliveira,
Carolina A. Silva,
Camila D. Barbieri,
Giselle M. Oliveira,
Dirce M. T. Zanetta,
and
Emmanuel A. Burdmann*
Division of Nephrology, Hospital de Base, São José do Rio Preto Medical School, Av. Brigadeiro Faria Lima, 5416, São José do Rio Preto, SP 15090-000, Brazil
Received 24 October 2008/ Returned for modification 20 January 2009/ Accepted 8 April 2009
In order to assess the prevalence of and risk factors for aminoglycoside-associated nephrotoxicity in intensive care units (ICUs), we evaluated 360 consecutive patients starting aminoglycoside therapy in an ICU. The patients had a baseline calculated glomerular filtration rate (cGFR) of 
30 ml/min/1.73 m2. Among these patients, 209 (58%) developed aminoglycoside-associated nephrotoxicity (the acute kidney injury [AKI] group, which consisted of individuals with a decrease in cGFR of >20% from the baseline cGFR), while 151 did not (non-AKI group). Both groups had similar baseline cGFRs. The AKI group developed a lower cGFR nadir (45 ± 27 versus 79 ± 39 ml/min/1.73 m2 for the non-AKI group; P < 0.001); was older (56 ± 18 years versus 52 ± 19 years for the non-AKI group; P = 0.033); had a higher prevalence of diabetes (19.6% versus 9.3% for the non-AKI group; P = 0.007); was more frequently treated with other nephrotoxic drugs (51% versus 38% for the non-AKI group; P = 0.024); used iodinated contrast more frequently (18% versus 8% for the non-AKI group; P = 0.0054); and showed a higher prevalence of hypotension (63% versus 44% for the non-AKI group; P = 0.0003), shock (56% versus 31% for the non-AKI group; P < 0.0001), and jaundice (19% versus 8% for the non-AKI group; P = 0.0036). The mortality rate was 44.5% for the AKI group and 29.1% for the non-AKI group (P = 0.0031). A logistic regression model identified as significant (P < 0.05) the following independent factors that affected aminoglycoside-associated nephrotoxicity: a baseline cGFR of <60 ml/min/1.73 m2 (odds ratio [OR], 0.42), diabetes (OR, 2.13), treatment with other nephrotoxins (OR, 1.61) or iodinated contrast (OR, 2.13), and hypotension (OR, 1.83). In conclusion, AKI was frequent among ICU patients receiving an aminoglycoside, and it was associated with a high rate of mortality. The presence of diabetes or hypotension and the use of other nephrotoxic drugs and iodinated contrast were independent risk factors for the development of aminoglycoside-associated nephrotoxicity.
* Corresponding author. Mailing address: Sao Jose do Rio Preto Medical School, Av. Brigadeiro Faria Lima 5416, São Jose do Rio Preto, SP 15090-000 Brazil. Phone: 55-17-32015712. Fax: 55-17-32162227. E-mail: burdmann{at}famerp.br
Published ahead of print on 13 April 2009.
Present address: School of Public Health, University of Sao Paulo, Departamento de Epidemiologia, sala 212, Av. Arnaldo 715, Sao Paulo, SP 01246-904, Brazil.
Antimicrobial Agents and Chemotherapy, July 2009, p. 2887-2891, Vol. 53, No. 7
0066-4804/09/$08.00+0 doi:10.1128/AAC.01430-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
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