Acute Kidney Injury With Tobramycin-Impregnated Bone Cement Spacers in Prosthetic Joint Infections.
BACKGROUND
Antibiotic-impregnated bone cement spacer (ACS) with tobramycin ± vancomycin is commonly used in a 2-stage replacement of infected prosthetic joints. This procedure has been associated with development of acute kidney injury (AKI).


OBJECTIVE
To determine the incidence and risk factors for AKI after implantation of tobramycin-impregnated ACS.


METHODS
This prospective, observational study evaluated 50 consecutive patients who received tobramycin ACS for first-stage revision of an infected hip or knee arthroplasty from August 2011 to February 2013. AKI was defined as 50% or greater rise in serum creatinine (SCr) from baseline within the first 7 postoperative days (PODs).


RESULTS
The incidence of AKI was 20%, with median onset occurring at POD 2 (interquartile range [IQR] = 1-3); patients with AKI had a longer median duration of hospital stay (16 days, IQR = 12-17, vs 10 days, IQR = 8-10; P = 0.03). Serum tobramycin concentrations were significantly higher in the AKI group, peaking on POD 1 (median 1.9 vs 0.9 µg/mL, P = 0.01). Risk factors for nephrotoxicity identified by multivariate analysis were use of bone cement premanufactured with gentamicin (OR = 8.2; 95% CI = 1.1-60; P = 0.04), administration of blood transfusions intraoperatively (OR = 32.5; 95% CI = 2.3-454.3; P = 0.01) and nonsteroidal anti-inflammatory drugs postoperatively (OR = 23.0; 95% CI = 1.3-397.7; P = 0.03).


CONCLUSIONS
Tobramycin ACS is associated with a high risk of AKI. Measures to minimize AKI risk in the perioperative period include early detection through close monitoring of SCr, avoiding use of premanufactured bone cement containing gentamicin, and avoiding potential nephrotoxins within the first 72 hours postoperatively.
Surrey Memorial Hospital, Surrey, BC, Canada.
Elissa S Y
ES
Aeng
Vancouver General Hospital, Vancouver, BC, Canada karen.shalansky@vch.ca.
Karen F
KF
Shalansky
Vancouver General Hospital, Vancouver, BC, Canada.
Tim T Y
TT
Lau
Vancouver General Hospital, Vancouver, BC, Canada.
Nadia
N
Zalunardo
Vancouver General Hospital, Vancouver, BC, Canada.
Guiyun
G
Li
Vancouver General Hospital, Vancouver, BC, Canada.
William R
WR
Bowie
Vancouver General Hospital, Vancouver, BC, Canada.
Clive P
CP
Duncan
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements; D003404:Creatinine / Q000097:blood; D005260:Female; D005839:Gentamicins / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000139:chemically induced*; D014031:Tobramycin / Q000009:adverse effects*; D014640:Vancomycin / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins; D014640:Vancomycin; D003404:Creatinine; D014031:Tobramycin
aminoglycosides; bone/joint disorders; drug delivery; infectious diseases; nephrotoxicity; orthopedics; surgery; vancomycin