Acute renal failure associated with vancomycin- and tobramycin-laden cement in total hip arthroplasty.
OBJECTIVE: To describe 2 cases of acute renal failure (ARF) associated with the use of antibiotic-laden cement incorporated in total hip arthroplasties (THA). CASE SUMMARIES: An 82-year-old female received a right THA with antibiotic-laden cement spacers. She developed ARF 5 months following implantation, concurrent with an elevated serum tobramycin concentration of 5.5 microg/mL. After explantation of the prosthesis and spacers, serum creatinine and antibiotic concentrations decreased to within normal limits. A 79-year-old male received antibiotic-laden cement spacers in a revision of his right THA due to infection. ARF developed 1 1/2 months after the revision; a serum tobramycin concentration was 2.9 microg/mL. Serum creatinine and antibiotic serum concentrations decreased to within normal limits with explantation. DISCUSSION: More than 250 000 joint replacements are performed yearly in the US. A common complication is infection, which occurs in 1-2% of primary replacements and 3-4% of revisions of previously infected prostheses. Antibiotic-laden cement is used for prosthesis placement to prevent or treat infection, while minimizing systemic drug exposure. Both patients described here received antibiotic-laden spacers during THA and subsequently developed ARF in conjunction with elevated serum tobramycin concentrations. Use of the Naranjo probability scale and consideration of possible contributing factors suggest a probable association of the antibiotic-laden cement and the development of ARF in these patients. CONCLUSIONS: Antibiotic-laden cement with aminoglycosides and/or vancomycin has the potential for systemic toxicity and should be used according to guidelines and with increased vigilance and prudent monitoring in patients at increased risk for nephrotoxicity.[1]References
- Acute renal failure associated with vancomycin- and tobramycin-laden cement in total hip arthroplasty. Patrick, B.N., Rivey, M.P., Allington, D.R. The Annals of pharmacotherapy. (2006) [Pubmed]
Annotations and hyperlinks in this abstract are from individual authors of WikiGenes or automatically generated by the WikiGenes Data Mining Engine. The abstract is from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.About WikiGenesOpen Access LicencePrivacy PolicyTerms of Useapsburg
