Acute Kidney Damage from Antibiotic-Loaded Spacers following
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Two-stage exchange arthroplasty with a high-dose antibiotic-loaded bone cement (ALBC) spacer and intravenous or oral antibiotics is the most common method of managing a periprosthetic joint infection (PJI) after a total knee arthroplasty (TKA). A Study was conducted to know about the contemporary incidence, the risk factors, and the outcomes of acute kidney injuries (AKIs) in this cohort.

424 patients who had been treated with 455 ALBC spacers after resection of a PJI following a primary TKA were identified. The mean age at resection was 67 years, the mean body mass index (BMI) was 33 kg/m2, 47% of the patients were women, and 15% had preexisting chronic kidney disease (CKD). The spacers contained a mean of 8 g of vancomycin and 9 g of an aminoglycoside per construct.

86 spacers also had amphotericin B (mean, 412 mg). All of the patients were concomitantly treated with systemic antibiotics for a mean of 6 weeks. An AKI was defined as a creatinine level of more than 1.5 times the baseline or an increase of more than 0.3 mg/dL within any 48-hour period. The mean follow-up was 6 years.

Results:
--54 AKIs occurred in 52 of the 359 patients without preexisting CKD versus 32 AKIs in 29 of the 65 patients with CKD; none required acute dialysis.

--Overall, when the vancomycin concentration or aminoglycoside concentration was more than 3.6 g/batch of cement, the risk of AKI increased (OR, 1.9 and 1.8, respectively for both).

--Hypertension (beta = 0.17), perioperative hypovolemia (beta = 0.28), and acute atrial fibrillation (beta = 0.13) were independent predictors for AKI in patients without preexisting CKD.

--At the last follow-up, 8 patients who had sustained an AKI had progressed to CKD, 4 of whom received dialysis.

After undergoing a 2-stage exchange arthroplasty for a PJI after TKA, 14% of patients with normal renal function developed AKI, and 2% developed CKD. Those with preexisting CKD, on the other hand, were five times more likely to develop AKI. AKI was predicted by the causes of acute renal blood flow deficiency, which were separate predictors.

Source: https://www.jbjs.org/reader.php?id=207800&rsuite_id=2813563&native=1&topics=kn if&source=The_Journal_of_Bone_and_Joint_Surgery/Publish+Ahead+of+Print//10.2106/JBJS.20.01825/abstract#info
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