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

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Case report
Timely explantation of tobramycin-impregnated beads and bone cement to avoid haemodialysis in a patient with worsening renal failure
  1. Joseph Jeffry Borick1,2,3,
  2. Shuba Balan1,2,3,
  3. Paola Lichtenberger1,3 and
  4. Lauren Bjork4
  1. 1Infectious Disease, University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2Infectious Disease, Jackson Memorial Hospital, Miami, Florida, USA
  3. 3Infectious Disease, VA Medical Center, Miami, Florida, USA
  4. 4Clinical Pharmacy, VA Medical Center Miami, Miami, Florida, USA
  1. Correspondence to Dr Joseph Jeffry Borick; josephborick{at}gmail.com

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.

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

https://doi.org/10.1136/bcr-2021-242760

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    Footnotes

    • Contributors All authors contributed to the conception and design of the work as well as drafting and revising it critically for important intellectual content. JJB was the main contributor for the summary, case presentation, investigations, treatment, outcome, follow-up and the figures as well as the submission of the article with the cover letter, etc. PL was the chief contributor to the learning points and provided oversight throughout the process. SB oversaw the differential and the references. LB was the main contributor to the Discussion. Final approval of the version published was given by all authors. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.