In the Journals

Antibiotic-loaded cement spacers yielded elevated systemic antibiotic concentrations after TJA

Among patients with periprosthetic joint infection, use of high-dose antibiotic-loaded cement spacers yielded elevated systemic antibiotic concentrations for at least 8 weeks after placement, posing a risk of systemic toxicity, according to results.

Adam I. Edelstein, MD, and colleagues found 21 patients with an infected primary total hip or knee arthroplasty treated with standardized antibiotic-loaded cement spacers had mean serum gentamicin levels between approximately 0.275 mg/L and 0.364 mg/L, mean serum tobramycin levels between approximately 0.313 mg/L and 0.527 mg/L, and mean serum vancomycin levels between approximately 5.46 mg/L and 15.34 mg/L.

Results showed patients treated with systemic vancomycin had greater serum vancomycin levels. However, researchers noted the serum vancomycin levels remained detectable in patients without systemic treatment. Although no patients had aminoglycoside levels above the nephrotoxicity threshold during the study, between 14.3% and 70% of patients had serum vancomycin concentrations above nephrotoxicity threshold depending on the week.

Regression analysis showed serum vancomycin levels correlated with diabetes, blood urea nitrogen, number of cement doses and use of systemic vancomycin. Researchers also found serum aminoglycoside levels correlated with patient age and male sex.

“Several recent studies have reported an alarmingly high rate of nephrotoxicity related to antibiotic-loaded cement spacers for treatment of periprosthetic joint infection,” Edelstein told Healio.com/Orthopedics. “Our study found that systemic absorption of antibiotics from these spacers persists for at least 8 weeks following placement. We believe that surgeons should monitor patients closely for systemic toxicity, particularly kidney injury, throughout the entire duration of treatment with an antibiotic cement spacer.” – by Casey Tingle

Disclosures: Edelstein reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

Among patients with periprosthetic joint infection, use of high-dose antibiotic-loaded cement spacers yielded elevated systemic antibiotic concentrations for at least 8 weeks after placement, posing a risk of systemic toxicity, according to results.

Adam I. Edelstein, MD, and colleagues found 21 patients with an infected primary total hip or knee arthroplasty treated with standardized antibiotic-loaded cement spacers had mean serum gentamicin levels between approximately 0.275 mg/L and 0.364 mg/L, mean serum tobramycin levels between approximately 0.313 mg/L and 0.527 mg/L, and mean serum vancomycin levels between approximately 5.46 mg/L and 15.34 mg/L.

Results showed patients treated with systemic vancomycin had greater serum vancomycin levels. However, researchers noted the serum vancomycin levels remained detectable in patients without systemic treatment. Although no patients had aminoglycoside levels above the nephrotoxicity threshold during the study, between 14.3% and 70% of patients had serum vancomycin concentrations above nephrotoxicity threshold depending on the week.

Regression analysis showed serum vancomycin levels correlated with diabetes, blood urea nitrogen, number of cement doses and use of systemic vancomycin. Researchers also found serum aminoglycoside levels correlated with patient age and male sex.

“Several recent studies have reported an alarmingly high rate of nephrotoxicity related to antibiotic-loaded cement spacers for treatment of periprosthetic joint infection,” Edelstein told Healio.com/Orthopedics. “Our study found that systemic absorption of antibiotics from these spacers persists for at least 8 weeks following placement. We believe that surgeons should monitor patients closely for systemic toxicity, particularly kidney injury, throughout the entire duration of treatment with an antibiotic cement spacer.” – by Casey Tingle

Disclosures: Edelstein reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.