Timely explantation of tobramycin-impregnated beads and bone cement to avoid haemodialysis in a patient with worsening renal failure

Joseph Jeffry Borick, Shuba Balan, Paola Lichtenberger, Lauren Bjork

Research output: Contribution to journalArticlepeer-review

Abstract

A male patient with right total knee arthroplasty complicated by prosthetic joint infection on intravenous antimicrobials developed an acute kidney injury (AKI) with creatinine up to 7.3 mg/dL ('normal' range (0.5-1.2 mg/dL)) after hardware removal and tobramycin loaded polymethylmethacrylate beads and spacer placement. The AKI was initially attributed to intravenous vancomycin. Despite discontinuing vancomycin, the AKI worsened. A tobramycin level was collected and resulted at 5.5 μg/mL. Due to high suspicion for aminoglycoside-induced renal toxicity and to prevent haemodialysis, the antibiotic cement spacer with tobramycin-impregnated beads was removed. After the removal, tobramycin level rapidly decreased and renal functions improved. AKI is an increasingly recognised complication related to antibiotic-loaded bone cement (ALBC) due to the systemic absorption of antibiotics. With this case we highlight the early recognition of ALBC-induced renal toxicity necessitating explantation of ALBC and beads in order to prevent haemodialysis and emphasise monitoring aminoglycoside levels in the early postoperative period.

Original languageEnglish (US)
Article numbere242760
JournalBMJ case reports
Volume15
Issue number2
DOIs
StatePublished - Feb 7 2022
Externally publishedYes

Keywords

  • bone and joint infections
  • infectious diseases
  • orthopaedics
  • renal medicine

ASJC Scopus subject areas

  • Medicine(all)

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