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The following is a summary of “Impact of aminoglycosides on survival rate and renal outcomes in patients with urosepsis: a multicenter retrospective study,” published in the April 2025 issue of Annals of Intensive Care by Rozenblat et al. 

Combination therapy along with a beta-lactam and an aminoglycoside was advised for the empirical treatment of urosepsis, with nephrotoxicity being the most common side effect of aminoglycosides and acute kidney injury (AKI) impacting prognosis in septic shock.  

Researchers conducted a retrospective study to assess the impact of empirical antibiotic therapy with or without an aminoglycoside on survival and renal outcomes in intensive care unit (ICU) patients with urosepsis.  

They included all adults admitted to 4 ICUs of 3 university hospitals within the Assistance Publique—Hôpitaux de Paris (APHP) for urinary sepsis or septic shock from January 2015 to May 2022. The primary outcome included 30-day mortality after ICU admission, while secondary outcomes was renal recovery, need for new renal replacement therapy (RRT), Major Adverse Kidney Events at day 30 (MAKE 30), and ICU length of stay. Propensity score weighting accounted for confounding by indication.  

The results showed that 580 patients were included, with a median age of 69 years (interquartile (IQR): 58–77) and 53.6% male. Of these, 57.8% were in septic shock, and 79.2% had AKI on admission. A total of 99.8% received a beta-lactam (with 444 receiving aminoglycosides and 136 without). The 30-day mortality rate was 10.5% (61/580). After propensity score weighting, mortality was 7.7% (7/91) in the aminoglycoside group compared to 12.1% (11/91) in the non-aminoglycoside group (adjusted hazard ratio [aHR] = 0.65 [0.35; 1.23], P = 0.19). No significant differences were found in renal recovery (aHR = 0.88 [0.49; 1.58], P = 0.67), need for new RRT (aHR = 1.01 [0.54; 1.88], P = 0.97), MAKE 30 (aHR = 0.94 [0.60; 1.50], P = 0.81), or ICU length of stay among survivors (aHR = 1.07 [0.87; 1.31], P = 0.53).  

Investigators concluded that including aminoglycosides in the empirical antibiotic therapy had not significantly improved 30-day survival in ICU patients admitted for urosepsis, but the use had not been associated with worse renal outcomes. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01469-5