Wilson A P, Sturridge M F, Treasure T
Department of Clinical Microbiology, University College and Middlesex Hospitals, London, UK.
J Antimicrob Chemother. 1990 Nov;26(5):713-20. doi: 10.1093/jac/26.5.713.
We have reviewed experience with aminoglycosides in cardiac surgical prophylaxis from 1984 to 1989. In the first two years, prospectively randomized trials (517 patients) allowed comparison of tobramycin (three-day course) with a non-toxic antibiotic, teicoplanin. A significant excess rise in serum creatinine was present at the end of the first postoperative week in patients given tobramycin (165 vs 149 patients, 95% CI 3-17 microM. P less than 0.01, which was most marked in ten oliguric patients with trough serum levels over 2 mg/l (95% CI 7-52 microM). However, no patient needed haemodialysis and only one case of possible ototoxicity was identified. During the next three years, of 912 patients given two to three days gentamicin, 29 patients were shown to have potentially toxic serum levels and oliguria. Three individual cases are described, including one of ototoxicity and one of nephrotoxicity neeeding haemodialysis. The hazards of aminoglycoside toxicity are probably small compared with the failure of other antibiotics to cover staphylococci that may later cause wound infection or endocarditis. However, surgeons should probably be advised to check the aminoglycoside level in all patients on the first post-operative day.
我们回顾了1984年至1989年期间氨基糖苷类药物在心脏手术预防中的应用经验。在最初两年，前瞻性随机试验（517例患者）对妥布霉素（三日疗程）与无毒抗生素替考拉宁进行了比较。在术后第一周结束时，接受妥布霉素治疗的患者血清肌酐显著升高（165例对149例患者，95%可信区间3 - 17微摩尔/升。P<0.01，在10例血清谷浓度超过2毫克/升（95%可信区间7 - 52微摩尔/升）的少尿患者中最为明显。然而，没有患者需要血液透析，仅发现1例可能的耳毒性病例。在接下来的三年中，912例接受两到三天庆大霉素治疗的患者中，有29例显示血清水平可能有毒且出现少尿。描述了3例个体病例，包括1例耳毒性和1例需要血液透析的肾毒性病例。与其他抗生素未能覆盖可能随后导致伤口感染或心内膜炎的葡萄球菌相比，氨基糖苷类药物毒性的危害可能较小。然而，可能应该建议外科医生在术后第一天检查所有患者的氨基糖苷类药物水平。
