Does local implantation of gentamicin impair renal function in patients undergoing surgery for chronic bone infection?

Authors

  • Ross Muir The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, United Kingdom
  • Catherine Birnie The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, United Kingdom
  • Robert Hyder-Wilson The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, United Kingdom
  • Jamie Ferguson The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, United Kingdom
  • Martin A. McNally The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, United Kingdom http://orcid.org/0000-0003-2003-9044

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20211599

Keywords:

Osteomyelitis, Gentamicin, Nephrotoxicity, Surgery, Biomaterial

Abstract

Background: The treatment of chronic bone infection often involves excision of dead bone and implantation of biomaterials which elute antibiotics. Gentamicin is a preferred drug for local delivery, but its systemic use carries a well-established risk of nephrotoxicity.  We aim to establish the risk of acute kidney injury (AKI) with local delivery in a ceramic carrier.

Methods: 163 patients with Cierny-Mader type 3 or 4 chronic osteomyelitis had a single-stage operation including filling of the osseous defect with a calcium sulphate-hydroxyapatite carrier containing gentamicin. Mean gentamicin dosing was 191.3 mg (maximum 525 mg). Glomerular filtration rate (GFR) was calculated pre-operatively and during the first seven days post-operatively. Renal impairment was graded using the chronic kidney disease (CKD) staging system, and AKI was assessed using the RIFLE criteria.

Results: 155 cases had adequate data to allow calculation of pre- and post-operative GFR. 7 had pre-existing renal disease. 70 patients (45.2%) had a temporary GFR drop post-operatively, with the greatest decrease occurring at a mean of 3.06 days following surgery. Twenty cases had a >10% decline in GFR, but 12 resolved within 7 days. 7 patients transiently fell into the “Risk” category according to RIFLE criteria, but no patient had a change consistent with “Injury”, “Failure” or “Loss” of renal function and none had clinical signs of new acute renal impairment post-operatively. 

Conclusions: Renal function is not significantly affected by local implantation of gentamicin up to 525 mg. The presence of pre-existing renal disease is not a contraindication to local gentamicin therapy.

 

Author Biography

Martin A. McNally, The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, United Kingdom

Lead Surgeon, Oxford Bone Infection Unit

King James IV Professor, RCS Edinburgh

Honorary Senior Lecturer in Orthopaedic Surgery

University of Oxford

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Published

2021-04-26

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Original Research Articles