Acute Kidney Injury with Tobramycin-lmpregnated Bone Cement Spacers in Prosthetic Joint Infections: Specialties in Pharmacy Practice Award, sponsored by Sandoz Canada Inc.

摘要

Introduction: Antibiotic-impregnated bone cement spacer (ACS) with tobramycin ± vancomycin is commonly used in a two-stage replacement of infected prosthetic joints. This procedure has been associated with development of acute kidney injury (AKI). The objective of this study was 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 Aug 2011 to Feb 2013. AKI was defined as 50% or greater rise in serum creatinine (SCr) from baseline within the first 7 postoperative days. 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 mg/L vs 0.9 mg/L, p=0.01). Risk factors for nephrotoxicity identified by multivariate analysis were use of bone cement pre-manufactured 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 non-steroidal anti-inflammatory drugs postoperatively (OR = 23.0; 95% CI = 1.3-397.7, p=0.03). Discussion: We found a 20% incidence of AKI in patients with infected joint arthroplasties receiving tobramycin ACS which is comparable to other reports. AKI is a known risk factor for chronic kidney disease. Conclusion: Tobramycin ACS for treatment of prosthetic joint infections is associated with a high risk of AKI. Measures to minimize AKI risk in the perioperative period include close monitoring of SCr, and avoiding pre-manufactured bone cement containing gentamicin and potential nephrotoxins.