Acute Tubular Necrosis Associated With High Serum Vancomycin and Tobramycin Levels After Revision of Total Knee Arthroplasty With Antibiotic-Containing Calcium Sulfate Beads

Ma, Adrienne H.; Hoffman, Courtney; Mcneil, John I

doi:10.1093/ofid/ofz141

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…Additionally, IO antibiotics are more effective than IV use to inhibit the risk of Gram-positive bacteria. In patients with joint replacement, the incidence of AKI ranges from 1% to 20%, and after IO use, the vancomycin concentration in the serum was lower than that of the venous concentration, and so it has less effect on renal function ( 19 , 20 , 21 ). However, our study found no difference in the incidence of AKI between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Intraosseous regional prophylactic antibiotics decrease the risk of infection in total knee arthroplasty compared with intravenous antibiotics: a systematic review and meta-analysis

Xiang

Yang

et al. 2023

EFORT Open Reviews

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Purpose Surgical site infection (SSI) is a rare and serious complication of total knee arthroplasty (TKA), which causes a poor prognosis for patients. The purpose of this study was to explore the effect of intraosseous (IO) antibiotics in preventing infection and complications after TKA compared with intravenous (IV) antibiotics and to provide a certain theoretical basis for clinical treatment. Methods The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed, Embase, Ovid, Web of Science, and the Cochrane Central Register of Controlled Trials databases about trials on IO antibiotics (into the proximal tibia before skin incision) to prevent infections in TKA from the respective inception dates to September 30, 2022. The infection occurred within 3 months after surgery. Both researchers individually screened the studies in accordance with the inclusion and exclusion criteria, performed the literature quality evaluation and data extraction, and used Stata 17 software for data analysis. Results Five studies that enrolled 3801 patients were included in this meta-analysis. The results showed that IO antibiotics were effective in reducing the incidence of SSI (OR: 0.25, P = 0.001) and periprosthetic joint infections (OR: 0.16, P = 0.004) relative to IV. Moreover, the percentage of infection due to Gram-positive bacteria (OR: 0.18, P = 0.025) was reduced in the IO group compared with that in IV group, but Gram-negative bacteria levels were not significantly reduced (P = 0.14). There was no difference between the two groups for other systemic adverse effects of the drug. Conclusions IO antibiotics in TKA are safe and effective alternatives to IV antibiotics. Large randomized clinical studies comparing infection rates and related complications with IO and IV antibiotics are required.

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Section: Discussionmentioning

confidence: 99%

Intraosseous regional prophylactic antibiotics decrease the risk of infection in total knee arthroplasty compared with intravenous antibiotics: a systematic review and meta-analysis

Xiang

Yang

et al. 2023

EFORT Open Reviews

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“…Over time, renal function without dialysis improved. [11] It is interesting to note that the company that produces Stimulan® beads does not support the addition of antibiotics to its bone filler product. However, tobramycin is listed in 2 doses on the product insert: 240 mg for the reconstituted intravenous solution and 1.2 g for the powder formulation.…”

Section: The Authors Have No Funding and Conflicts Of Interest To Dis...mentioning

confidence: 99%

Assessing tobramycin levels and renal function following the implantation of CaSO4 beads impregnated with tobramycin: A prospective cohort study

Alowais

Wali

Tabb³

et al. 2022

Medicine

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This study aimed to evaluate the risk of serum tobramycin concentrations exceeding therapeutic levels after administration of calcium sulfate (CaSO 4 ) beads containing either 240 mg or 400 mg tobramycin and 1000 mg vancomycin. This single-center, prospective. This single-center, prospective study included included Piedmont Columbus, Regional orthopedic surgery patients. Following the implantation of tobramycin into CaSO 4 beads, serially measured serum tobramycin concentrations were evaluated after 6, 12, 24, and 48 hours. In addition to that, serum tobramycin concentration was evaluated after 5 days. None of the patients who received 240 mg tobramycin-impregnated beads had a tobramycin level >2 μg/mL. Six hours after implantation, the tobramycin level in 2 out of 2 (100%) patients who received 400 mg of tobramycin-impregnated beads was >2 μg/mL. One day following the surgery, the median serum creatinine was 0.85 mg/dL, with an interquartile range of 0.73 to 1.04 mg/dL. No cases of acute kidney injury were observed. This cohort demonstrated that non-nephrotoxic serum tobramycin levels could be achieved in CaSO 4 beads mixed with 240 mg or 400 mg of tobramycin.Abbreviations: CaSO 4 = calcium sulfate, POD = postoperative day, SD = standard deviation.

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“…The rate of AKI has been associated with patient comorbidities [18,19]. A large contributor to that incidence is patients who have high serum concentrations of vancomycin [20], as well as in those who receive dual antibiotic prophylaxis (cefazolin and vancomycin) [21]. IO administration of vancomycin after tourniquet inflation has been shown to keep serum concentrations nondetectable during surgery [3].…”

Section: Type Of Complicationmentioning

confidence: 99%

Clinical outcome evaluation of intraosseous vancomycin in total knee arthroplasty

et al. 2020

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Background: Vancomycin is a commonly used prophylactic antibiotic for total joint replacement surgery to protect against methicillin-resistant Staphylococcus aureus. Studies have suggested intraosseous (IO) infusions provide superior local tissue antibiotic concentration compared with intravenous (IV) access in total knee arthroplasty (TKA). We reviewed patients receiving IO vancomycin before TKA, comparing complication rates to a matched group receiving IV prophylactic vancomycin. Methods: Retrospective review of TKA patients administered IO vancomycin (500 mg vancomycin in 200 mL normal saline),

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Acute Tubular Necrosis Associated With High Serum Vancomycin and Tobramycin Levels After Revision of Total Knee Arthroplasty With Antibiotic-Containing Calcium Sulfate Beads

Cited by 7 publications

References 12 publications

Intraosseous regional prophylactic antibiotics decrease the risk of infection in total knee arthroplasty compared with intravenous antibiotics: a systematic review and meta-analysis

Intraosseous regional prophylactic antibiotics decrease the risk of infection in total knee arthroplasty compared with intravenous antibiotics: a systematic review and meta-analysis

Assessing tobramycin levels and renal function following the implantation of CaSO4 beads impregnated with tobramycin: A prospective cohort study

Clinical outcome evaluation of intraosseous vancomycin in total knee arthroplasty

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