The Safety of Single Aminoglycoside Dose in Emergency Departments ( SAD ‐ ED ) Among Patients With and Without Chronic Kidney Disease: A Retrospective Cohort Study

Abstract

ABSTRACT Objective Nephrotoxicity has been reported with prolonged use of aminoglycosides but is considered low‐risk with single‐dose empirical therapy. However, limited data exist in patients with chronic kidney disease (CKD). The aim of this study was to determine the safety of single‐dose aminoglycosides (SDA) in Emergency Departments (ED) in patients with and without CKD. Methods A retrospective cohort study was performed in four tertiary hospitals within a multi‐site Australian metropolitan hospital network. Electronic medical records of all adult patients who presented to ED and received SDA between August 2019–July 2024 were screened for inclusion. The primary outcome was AKI incidence within 1 week of SDA. Results Overall, 6636 aminoglycoside administrations were identified, 1835 screened and 660 patients were included. Patients received gentamicin (74.1%), tobramycin (25.6%), or amikacin (0.3%). Patients with CKD were older (81.3 vs. 64.1 years, p < 0.001) and had more comorbidities. AKI incidence within 1 week of hospitalisation was higher in patients with vs. without CKD (30.9% vs. 13.4%, p < 0.001). Patients with CKD had more severe AKI (stage 2: 10.1% vs. 2.6%, p < 0.001) and had numerically, but not statistically, higher mortality and intensive care unit admission rates compared to patients without CKD. CKD was associated with a higher likelihood of AKI incidence (OR 2.88 [95% CI: 1.76–4.71], p < 0.001). Conclusions Patients with CKD who received single‐dose aminoglycosides were more likely to have AKI compared to patients without CKD. Clinicians should carefully balance the risks and benefits of empiric aminoglycosides in patients with CKD and consider such therapy only if no other suitable alternatives exist.