Acute Renal Failure Related to Implanted Antibiotic Impregnated Cement Joint Spacer

A 68-year-old female patient with extensive preexisting renal disease underwent explantation of an infected total knee arthroplasty with the common practice of inserting a cement spacer impregnated with both tobramycin and vancomycin. Four weeks later, she presented with acute renal failure, a toxic serum level of tobramycin, and a still detectable serum vancomycin level. This case illustrates the fact that systemic levels of potentially toxic antibiotics may be detectable weeks after implantation of the antibiotic-impregnated cement. More data are needed to rationally recommend nontoxic, heat-stable antibiotics that could be added to the orthopedically stabilizing spacers in 2-step replacements of infected prosthetic joints. Careful screening of patients for renal disease and risk is essential before using potentially toxic antimicrobial drugs for this purpose.