Intraoperative Anaphylactic Shock Associated With Bacitracin Irrigation During Revision Total Knee Arthroplasty

Antevil, Jared L.; Muldoon, Michael; Battaglia, Michael; Green, Richard

doi:10.2106/00004623-200302000-00024

Cited by 33 publications

(14 citation statements)

References 21 publications

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“…Her skin test showed a strong reaction to bacitracin, supporting anaphylaxis as the inciting event [8]. The patient subsequently reported using a topical antibiotic ointment containing bacitracin for chronic sinusitis.…”

Section: Discussionmentioning

confidence: 88%

Successful resuscitation of a patient who developed cardiac arrest from pulsed saline bacitracin lavage during thoracic laminectomy and fusion

Greenberg

Deshur

Khavkin

et al. 2008

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 88%

Successful resuscitation of a patient who developed cardiac arrest from pulsed saline bacitracin lavage during thoracic laminectomy and fusion

Greenberg

Deshur

Khavkin

et al. 2008

Journal of Clinical Anesthesia

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“…Despite such exhaustive prophylactic measures, intraoperative contamination is still possible 2 , thus leading to the recommendation for use of diluted topical antibiotics for irrigation to reduce intra-and post-operative wound infection has been recommended 11,12,[29][30][31] . There have however been reports of anaphylactic reactions following the use of Bacitracin irrigation 13,17 , and systemic absorption is also a concern [18][19][20][21] . This raises the issue of and concern about the safety of using diluted topical antibiotics irrigation in surgical wounds.…”

Section: Discussionmentioning

confidence: 99%

“…The introduction of antibiotic cement in cemented joint arthroplasty surgery has also had a beneficial in the reduction of deep sepsis following joint replacement surgery 10 . Attempts to further reduce the incidence of post-operative wound sepsis also have included topical antibiotic irrigation during prosthesis implantation 11,12 , however the practice remains controversial due to reports of adverse effects and lack of clinical efficacy documentation in the literature [13][14][15] . The primary objective of this study was to determine whether systemic absorption occurs after topical gentamicin irrigation during joint replacement surgery.…”

Section: Introductionmentioning

confidence: 99%

Systemic Absorption of Gentamicin Irrigation in Joint Replacement Surgery: A cause of concern

Kh¹,

Ng²,

Tan³

et al. 2008

MOJ

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Gentamicin, whether administered either intravenously, incorporated into bone cement or for local intra-operative irrigation, is a commonly used antibiotic in orthopaedic practice. The former two have been well studied, however the literature on the therapeutic efficacy and safety of gentamicin irrigation is sparse. The objective of this study was to assess systemic absorption of gentamicin irrigation in joint replacement surgery. This was a non-randomised, prospective study. Ninety-eight patients (group A) who underwent total joint replacement and 40 patients (group B) who underwent hemi-arthroplasty were treated intraoperatively with gentamicin irrigation. Serum gentamicin levels were assayed at 4 hours and 24 hours post-surgery. Sixteen of 98 patients in group A (16%) and 12 out of 40 patients in group B (30%) were found to have serum gentamicin level above 2mcg/ml at 4 hours post-surgery. We conclude that intra-articular gentamicin irrigation is systemically absorbed at substantial levels.

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“…Reactions to bacitracin seem to occur particularly when the skin barrier is not intact. Surgical irrigation fluid containing bacitracin was recently identified as the agent provoking anaphylaxis in a patient undergoing knee arthroplasty [9]. Bacitracin as an allergen in adverse reactions is the subject of a recent short review [10].…”

Section: Bacitracinmentioning

confidence: 99%

Antibiotic allergy: Immunochemical and clinical considerations

Baldo¹,

Zhao²,

Pham³

2008

Curr Allergy Asthma Rep

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Antibiotics are among the most widely and heavily prescribed drugs, but despite this, allergic reactions to most groups of antibiotics are relatively uncommon-especially when compared with the number and frequency of type 1 hypersensitivity responses to the beta-lactams (ie, penicillins, cephalosporins, and, to a lesser extent, carbopenems). Still, there remains a steady flow of reports of allergic reactions to some topically used antibiotics (eg, rifamycin SV and bacitracin). Moreover, aminoglycosides (eg, neomycin and gramicidin) may be implicated more often than previously suspected. Despite advances in our understanding of the structural basis of the allergenicity of beta-lactam antibiotics, the insights have not readily transferred into routine use to improve diagnoses of reactions to individual penicillins and cephalosporins. This remains a challenge in drug allergy, as does the need for further chemical, immunologic, and clinical research on cephalosporin breakdown products and the so-called multiple antibiotic allergy syndrome.

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Intraoperative Anaphylactic Shock Associated With Bacitracin Irrigation During Revision Total Knee Arthroplasty

Cited by 33 publications

References 21 publications

Successful resuscitation of a patient who developed cardiac arrest from pulsed saline bacitracin lavage during thoracic laminectomy and fusion

Successful resuscitation of a patient who developed cardiac arrest from pulsed saline bacitracin lavage during thoracic laminectomy and fusion

Systemic Absorption of Gentamicin Irrigation in Joint Replacement Surgery: A cause of concern

Antibiotic allergy: Immunochemical and clinical considerations

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