The treatment for periprosthetic joint infection frequently involves the placement of a high-dose antibiotic-loaded bone cement spacer (ALCS) into the debrided joint. Typical antibiotics in the spacer include aminoglycosides and vancomycin. It has been believed that systemic absorption of intraarticular antibiotics would be low and early experience suggested that the risk of acute kidney injury (AKI) from ALCS was minimal. However, recent case reports and case series have suggested a risk of acute kidney injury due to antibiotic absorption, though confounding factors are common. We report a case of severe AKI requiring hemodialysis with extremely high systemic tobramycin levels after the placement of an ALCS with increased dosing of antibiotics after previous failure to resolve a periprosthetic joint infection with a prior ALCS. There was no concomitant use of intravenous nephrotoxic antibiotics nor other confounding factors. Despite dialysis, the patient needed urgent removal of the ALCS to control tobramycin levels with subsequent resolution of the AKI. This case highlights the potentially serious nephrotoxicity of ALCS's, the importance of antibiotic type and dosing, and the value of close monitoring after ALCS placement, especially in a patient with chronic kidney disease.

中文翻译：

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一例由于用于感染膝关节置换术的抗生素负载水泥垫片而导致的严重急性肾损伤。


假体周围关节感染的治疗通常涉及将高剂量负载抗生素的骨水泥垫片 （ALCS） 放置在清创关节中。储雾区的典型抗生素包括氨基糖苷类抗生素和万古霉素。据信，关节内抗生素的全身吸收率较低，早期经验表明 ALCS 导致急性肾损伤 （AKI） 的风险很小。然而，最近的病例报告和病例系列表明，抗生素吸收存在急性肾损伤的风险，尽管混杂因素很常见。我们报告了一例严重 AKI 需要血液透析，在放置 ALCS 后全身妥布霉素水平极高，在先前未能解决先前 ALCS 的假体周围关节感染后增加抗生素剂量。没有同时使用静脉注射肾毒性抗生素或其他混杂因素。尽管进行了透析，但患者需要紧急去除 ALCS 以控制妥布霉素水平，随后 AKI 消退。该病例强调了 ALCS 的潜在严重肾毒性、抗生素类型和剂量的重要性，以及 ALCS 放置后密切监测的价值，尤其是对于慢性肾病患者。