Balancing between sepsis, AKI and gentamicin in the emergency department

Sepsis is a life threatening disease. It is caused by an infection in which the body reacts very strongly to this infection. Because of this, organ failure can develop which can lead to death. In 2018, more than 5000 patients with sepsis were admitted to the Intensive Care Unit in the Netherlands. The number of patients with sepsis visiting the emergency room is many times higher.
Sepsis is treated with, among other things, antibiotics. Because we do not know which pathogen is the cause of the infection at presentation, broad-spectrum antibiotics are administered. These are antibiotics that work against many different types of bacteria.
In many hospitals in the Netherlands, aminoglycosides, such as gentamicin, are given as part of the treatment of broad spectrum antibiotics. Aminoglycosides are rapidly effective, there is little resistance to them, and they are cheap and easy to obtain. In addition, they can help reduce the use of reserve antibiotics.
However, aminoglycosides are not uncontroversial. This is because acute kidney injury is a major side effect. Since patients with sepsis already have a risk of acute kidney injury, it is sometimes difficult to differentiate what causes the acute kidney injury. Because of this, sometimes there is reluctance to administer aminoglycosides to patients with sepsis.