{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:13:31Z","timestamp":1793913211378,"version":"4.8.0"},"reference-count":46,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,12,31]]},"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:p>A male patient with right total knee arthroplasty complicated by prosthetic joint infection on intravenous antimicrobials developed an acute kidney injury (AKI) with creatinine up to 7.3 mg\/dL (\u2018normal\u2019 range (0.5-1.2 mg\/dL)) after hardware removal and tobramycin loaded polymethylmethacrylate beads and spacer placement. The AKI was initially attributed to intravenous vancomycin. Despite discontinuing vancomycin, the AKI worsened. A tobramycin level was collected and resulted at 5.5 \u00b5g\/mL. Due to high suspicion for aminoglycoside-induced renal toxicity and to prevent haemodialysis, the antibiotic cement spacer with tobramycin-impregnated beads was removed. After the removal, tobramycin level rapidly decreased and renal functions improved. AKI is an increasingly recognised complication related to antibiotic-loaded bone cement (ALBC) due to the systemic absorption of antibiotics. With this case we highlight the early recognition of ALBC-induced renal toxicity necessitating explantation of ALBC and beads in order to prevent haemodialysis and emphasise monitoring aminoglycoside levels in the early postoperative period.<\/jats:p>","DOI":"10.1136\/bcr-2021-242760","type":"journal-article","created":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T11:30:23Z","timestamp":1644233423000},"page":"e242760","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Timely explantation of tobramycin-impregnated beads and bone cement to avoid haemodialysis in a patient with worsening renal failure"],"prefix":"10.1136","volume":"15","author":[{"given":"Joseph Jeffry","family":"Borick","sequence":"first","affiliation":[{"name":"Infectious Disease, University of Miami Miller School of Medicine, Miami, Florida, USA"},{"name":"Infectious Disease, Jackson Memorial Hospital, Miami, Florida, USA"},{"name":"Infectious Disease, VA Medical Center, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuba","family":"Balan","sequence":"additional","affiliation":[{"name":"Infectious Disease, University of Miami Miller School of Medicine, Miami, Florida, USA"},{"name":"Infectious Disease, Jackson Memorial Hospital, Miami, Florida, USA"},{"name":"Infectious Disease, VA Medical Center, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Lichtenberger","sequence":"additional","affiliation":[{"name":"Infectious Disease, University of Miami Miller School of Medicine, Miami, Florida, USA"},{"name":"Infectious Disease, VA Medical Center, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Bjork","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy, VA Medical Center Miami, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,2,7]]},"reference":[{"key":"2025082707384218000_15.2.e242760.1","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1302\/2046-3758.812.BJR-2019-0340","article-title":"Prosthetic joint infection","volume":"8","author":"Ahmed","year":"2019","journal-title":"Bone Joint Res"},{"key":"2025082707384218000_15.2.e242760.2","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2019.01626","article-title":"Antibiotic-Loaded polymethylmethacrylate beads and spacers in treatment of orthopedic infections and the role of biofilm formation","volume":"10","author":"van Vugt","year":"2019","journal-title":"Front Microbiol"},{"key":"2025082707384218000_15.2.e242760.3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s00590-012-1062-4","article-title":"The successful use of vancomycin-impregnated cement beads in a patient with vancomycin systemic toxicity: a case report with review of literature","volume":"23","author":"Mounasamy","year":"2013","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2025082707384218000_15.2.e242760.4","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000143739.07632.7c"},{"key":"2025082707384218000_15.2.e242760.5","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000144476.43661.10"},{"key":"2025082707384218000_15.2.e242760.6","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2001.24444"},{"key":"2025082707384218000_15.2.e242760.7","doi-asserted-by":"crossref","DOI":"10.1590\/S1807-59322007000200002","article-title":"Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer","volume":"62","author":"Cabrita","year":"2007","journal-title":"Clinics"},{"key":"2025082707384218000_15.2.e242760.8","doi-asserted-by":"crossref","first-page":"123","DOI":"10.2106\/00004623-200200002-00017","article-title":"Hip prosthesis of antibiotic-loaded acrylic cement for the treatment of infections following total hip arthroplasty","volume":"84-A Suppl 2","author":"Wentworth","year":"2002","journal-title":"J Bone Joint Surg Am"},{"key":"2025082707384218000_15.2.e242760.9","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2002.34525"},{"key":"2025082707384218000_15.2.e242760.10","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1H173"},{"key":"2025082707384218000_15.2.e242760.11","doi-asserted-by":"publisher","DOI":"10.5414\/CNP69207"},{"key":"2025082707384218000_15.2.e242760.12","doi-asserted-by":"publisher","DOI":"10.3109\/0886022X.2015.1052949"},{"key":"2025082707384218000_15.2.e242760.13","first-page":"391","article-title":"Acute kidney injury following antibiotic spacer placement following two stage arthroplasty","volume":"3","author":"GS","year":"2014","journal-title":"Int J Pharm Sci Res"},{"key":"2025082707384218000_15.2.e242760.14","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1097\/IPC.0000000000000231","article-title":"Acute renal failure related to implanted antibiotic-impregnated cement joint spacer","volume":"23","author":"Roman","year":"2015","journal-title":"Infect Dis Clin Pract"},{"key":"2025082707384218000_15.2.e242760.15","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1111\/sdi.12639","article-title":"Aminoglycoside impregnated cement spacer precipitating acute kidney injury requiring hemodialysis","volume":"31","author":"Salim","year":"2018","journal-title":"Semin Dial"},{"key":"2025082707384218000_15.2.e242760.16","first-page":"1","article-title":"Acute renal failure due to a tobramycin and vancomycin spacer in revision two-staged knee arthroplasty","volume":"2018","author":"Patel","year":"20182018","journal-title":"Case Rep Nephrol"},{"key":"2025082707384218000_15.2.e242760.17","doi-asserted-by":"publisher","DOI":"10.1592\/phco.2005.25.6.876"},{"key":"2025082707384218000_15.2.e242760.18","doi-asserted-by":"publisher","DOI":"10.5414\/CNP69207"},{"key":"2025082707384218000_15.2.e242760.19","doi-asserted-by":"crossref","first-page":"692","DOI":"10.47102\/annals-acadmedsg.V42N12p692","article-title":"Acute kidney injury (AKI) with the use of antibiotic-impregnated bone cement in primary total knee arthroplasty","volume":"42","author":"Lau","year":"2013","journal-title":"Ann Acad Med Singap"},{"key":"2025082707384218000_15.2.e242760.20","article-title":"A case of an acute kidney injury secondary to an implanted aminoglycoside","volume":"75","author":"IM","year":"2009","journal-title":"Kidney Int"},{"key":"2025082707384218000_15.2.e242760.21","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.CC.K.00094"},{"key":"2025082707384218000_15.2.e242760.22","first-page":"3742","article-title":"A case report of acute interstitial nephritis associated with antibiotic-impregnated orthopedic bone-cement spacer","volume":"105","author":"McGlothan","year":"2012","journal-title":"Tenn Med"},{"key":"2025082707384218000_15.2.e242760.23","doi-asserted-by":"crossref","unstructured":"Minelli EB , Benini A . PMMA as drug delivery system and in vivo release from spacers. In: Infection and local treatment in orthopedic surgery. Berlin, Heidelberg: Springer Berlin Heidelberg, 2007: 79\u201391. http:\/\/link.springer.com\/10.1007\/978-3-540-47999-4_11","DOI":"10.1007\/978-3-540-47999-4_11"},{"key":"2025082707384218000_15.2.e242760.24","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1002\/jbm.b.31281","article-title":"Enhancement of antibiotic elution from acrylic bone cement","volume":"90","author":"Anagnostakos","year":"2009","journal-title":"J Biomed Mater Res B Appl Biomater"},{"key":"2025082707384218000_15.2.e242760.25","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.43.5.1003"},{"key":"2025082707384218000_15.2.e242760.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.02.035"},{"key":"2025082707384218000_15.2.e242760.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2011.12.005"},{"key":"2025082707384218000_15.2.e242760.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.04.054"},{"key":"2025082707384218000_15.2.e242760.29","doi-asserted-by":"publisher","DOI":"10.1177\/1060028015600176"},{"key":"2025082707384218000_15.2.e242760.30","doi-asserted-by":"crossref","first-page":"29","DOI":"10.7150\/jbji.16067","article-title":"Therapeutic use of Antibiotic-loaded bone cement in the treatment of hip and knee joint infections","volume":"2","author":"Anagnostakos","year":"2017","journal-title":"J Bone Jt Infect"},{"key":"2025082707384218000_15.2.e242760.31","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1R049"},{"key":"2025082707384218000_15.2.e242760.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2008.07.009"},{"key":"2025082707384218000_15.2.e242760.33","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0199-2"},{"key":"2025082707384218000_15.2.e242760.34","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.E.01070"},{"key":"2025082707384218000_15.2.e242760.35","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(96)80135-5"},{"key":"2025082707384218000_15.2.e242760.36","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/00003086-199205000-00037","article-title":"In vitro and in vivo evaluation of antibiotic diffusion from antibiotic-impregnated polymethylmethacrylate beads","volume":"278","author":"Adams","year":"1992","journal-title":"Clin Orthop Relat Res"},{"key":"2025082707384218000_15.2.e242760.37","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(98)90179-6"},{"key":"2025082707384218000_15.2.e242760.38","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1089\/sur.2014.044","article-title":"Lack of efficacy of prophylactic application of antibiotic-loaded bone cement for prevention of infection in primary total knee arthroplasty: results of a meta-analysis","volume":"16","author":"Zhou","year":"2015","journal-title":"Surg Infect"},{"key":"2025082707384218000_15.2.e242760.39","doi-asserted-by":"crossref","first-page":"839","DOI":"10.3928\/01477447-20141124-07","article-title":"No decreased infection rate when using antibiotic-impregnated cement in primary total joint arthroplasty","volume":"37","author":"Yi","year":"2014","journal-title":"Orthopedics"},{"key":"2025082707384218000_15.2.e242760.40","doi-asserted-by":"crossref","first-page":"946","DOI":"10.5312\/wjo.v8.i12.946","article-title":"Antibiotic bone cement's effect on infection rates in primary and revision total knee arthroplasties","volume":"8","author":"Kleppel","year":"2017","journal-title":"World J Orthop"},{"key":"2025082707384218000_15.2.e242760.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.08.009"},{"key":"2025082707384218000_15.2.e242760.42","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1089\/sur.2018.123","article-title":"Does the use of antibiotic-loaded bone cement have an effect on deep infection in primary total knee arthroplasty practice?","volume":"20","author":"Turhan","year":"2019","journal-title":"Surg Infect"},{"key":"2025082707384218000_15.2.e242760.43","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0082745"},{"key":"2025082707384218000_15.2.e242760.44","doi-asserted-by":"crossref","first-page":"3168","DOI":"10.1007\/s00167-016-4301-0","article-title":"Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review","volume":"24","author":"Schiavone Panni","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"2025082707384218000_15.2.e242760.45","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v6.i11.877"},{"key":"2025082707384218000_15.2.e242760.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2014.02.032"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-242760","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:38:51Z","timestamp":1756305531000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-242760"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,7]]},"published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1136\/bcr-2021-242760"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-242760","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2]]}}}