This study evaluated the incidence of acute kidney injury (AKI) in patients treated with amikacin following autologous HSCT, providing safety data on short-term amikacin use and offering clinical evidence for optimizing empirical antibiotic strategies.
Literature Overview
This article, titled 'Incidence of Acute Kidney Injury in Autologous Hematopoietic Stem Cell Transplant Recipients According to the Administration of Empirical Amikacin: A Two-Centre Retrospective Cohort Study', published in the journal Antibiotics, reviews and summarizes the AKI incidence following empirical amikacin use in autologous HSCT patients and its relationship with antibiotic regimens. The study analyzed retrospective data from 250 patients, including 125 from University Hospital Basel (amikacin group) and 125 from University Hospital Bern (non-amikacin group). It focused on AKI incidence within seven days of antibiotic therapy and assessed whether short-term amikacin use causes significant renal impact.
Background Knowledge
Autologous HSCT is a common treatment for hematologic malignancies like multiple myeloma and lymphoma. However, post-transplant patients often experience severe immunosuppression, making them susceptible to febrile neutropenia (FN) or severe infections requiring immediate empirical antibiotic therapy. Current FN treatment strategies primarily include de-escalation therapy (broad-spectrum antibiotics plus aminoglycosides) and escalation therapy (monotherapy), with the latter being more suitable in regions with low drug resistance rates. Amikacin, an aminoglycoside antibiotic, demonstrates strong Gram-negative bacterial coverage but carries nephrotoxicity risks due to drug accumulation in proximal tubular cells. Patients with multiple myeloma often have pre-existing renal damage from light-chain deposition, hypercalcemia, or drug toxicity, making the risk-benefit assessment of amikacin addition in empirical therapy particularly critical. Recent data on amikacin use in HSCT patients and its renal effects remain limited, and this study fills this evidence gap by comparing AKI incidence between different treatment strategies.
Research Methods and Experiments
This multicenter retrospective cohort study between University Hospitals Basel and Bern included adult patients who received empirical antibiotic therapy after autologous HSCT between 2016 and 2022. The amikacin group (n=125) received β-lactam combined with amikacin, while the non-amikacin group (n=125) received β-lactam monotherapy. Primary endpoint was AKI incidence within 7 days post-antibiotic initiation. Secondary endpoints included AKI incidence within 14 days, renal recovery patterns, AKI risk factors, eGFR changes, amikacin dose appropriateness, and 90-day all-cause mortality. AKI diagnosis followed KDIGO criteria, with eGFR calculated via CKD-EPI equation to assess renal function changes. Concomitant use of other nephrotoxic drugs (e.g., NSAIDs, vancomycin, or diuretics) was also evaluated to exclude potential confounding factors.
Key Conclusions and Perspectives
Research Significance and Prospects
This study provides the first evaluation of empirical amikacin's impact on AKI incidence in multiple myeloma and lymphoma patients. While amikacin didn't significantly increase AKI rates within 7 days, the greater eGFR decline suggests cautious administration in specific populations. Future research should explore amikacin's application value across different resistance regions and renal function statuses through prospective randomized controlled trials. The study recommends prioritizing monotherapy in low-resistance settings, reserving combination therapy for specific high-risk infections or bacteremia cases.
Conclusion
This retrospective cohort study analyzed 250 autologous HSCT patients to determine antibiotic-AKI relationships. Results showed no significant difference in 7-day AKI incidence between amikacin users and non-users, but greater eGFR decline in amikacin group. It highlights short-term amikacin safety in patients with normal/mild renal function while emphasizing limited clinical benefit in low-resistance regions. These findings provide critical evidence for optimizing antibiotic strategies in post-HSCT FN patients, advocating for individualized treatment selection based on clinical context and further investigation into antibiotic regimens under varying resistance scenarios.
