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Aminoglycoside impregnated cement spacer precipitating acute kidney injury requiring hemodialysis
Author(s) -
Salim Sohail Abdul,
Everitt Jessica,
Schwartz Aaron,
Agarwal Mohit,
Castenada Jorge,
Fülöp Tibor,
Juncos Luis A.
Publication year - 2017
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12639
Subject(s) - medicine , tobramycin , acute tubular necrosis , aminoglycoside , hemodialysis , acute kidney injury , vancomycin , renal function , antibiotics , renal replacement therapy , creatinine , surgery , intensive care medicine , gentamicin , staphylococcus aureus , genetics , bacteria , microbiology and biotechnology , biology
The current standard of care for prosthetic joint infection includes two‐stage arthroplasty, with antibiotic‐impregnated cement spacers ( ACS ) utilized between the stages. We report a 75‐year‐old woman with previously normal renal function, who developed acute kidney injury ( AKI ) secondary to biopsy‐proven acute tubular necrosis and acute interstitial nephritis after ACS placement containing tobramycin and vancomycin. Peak tobramycin level measured 25.3 mcg/mL, the highest value reported in the literature after ACS placement. Intermittent hemodialysis was initiated with subsequent full recovery of renal function. This paper reviews the published literature regarding the accumulation, toxicity and removal dynamics of aminoglycoside ( AG ) antibiotics and vancomycin in renal patients. Obtaining serum AG level should be strongly considered in patients experiencing AKI after ACS . Renal replacement therapy may assist in reducing toxic AG levels.