DRESS syndrome induced by antibiotic-loaded bone cements and a diagnostic algorithm for related delayed-type hypersensitivity reactions

Drug allergy management in the elderly

“…He was labelled with suspected allergy to a multitude of perioperative medications including multiple classes of antibiotics. Had we not undergone complete workup, we would have been unable to identify that the culprit was in fact vancomycin in the bone cement [39]. However, we needed to discuss with the patient in length the indications for testing and the risk of another severe reaction regardless of what the in vitro and in vivo skin tests indicated.…”

Antimicrobial‐impregnated bone cement use in Australian hospitals: scoping pharmacist awareness and involvement in management

“…The true rate of systemic toxicities associated with AIBC is unclear, but the increasing incidence of adverse events published in the peer-reviewed literature illustrates the risk is evident and active monitoring is warranted. [12][13][14][15][16]24 There remains a lack of clarity regarding the usage of AIBC in Australian hospitals, including the range of antibiotics and doses used. If all hospital pharmacies took on the responsibility of managing commercially available AIBC, usage data could be retrieved and contributed to the NAUSP to enable benchmarking between sites and facilitate quality improvement.…”

“…Furthermore, the inappropriate use of antimicrobials in bone cement may contribute to AMR. The true rate of systemic toxicities associated with AIBC is unclear, but the increasing incidence of adverse events published in the peer‐reviewed literature illustrates the risk is evident and active monitoring is warranted 12–16,24 …”

“…Cases of drug rash with eosinophilia and systemic symptoms syndrome (DRESS) and nephrotoxicity associated with AIBC have been reported. [12][13][14][15] Additionally, increased aminoglycoside resistance rates have been reported in patients with prior aminoglycosideimpregnated cement spacers use in in chronic PJI. 16 It is anticipated that the use of AIBC will continue to increase with the ageing population and an increasing incidence of hip and knee arthroplasties, therefore determining the effectiveness and the incidence of adverse effects is essential.…”

“…Given the paucity of pharmacokinetic data in this setting, there is a risk of systemic leaching of antimicrobials and the potential for adverse events. Cases of drug rash with eosinophilia and systemic symptoms syndrome (DRESS) and nephrotoxicity associated with AIBC have been reported 12–15 . Additionally, increased aminoglycoside resistance rates have been reported in patients with prior aminoglycoside‐impregnated cement spacers use in in chronic PJI 16 …”