Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2018 Mar;33(3):835-839. doi: 10.1016/j.arth.2017.09.043. Epub 2017 Oct 5.
Two-stage treatment of periprosthetic joint infections involves placement of high-dose antibiotic-loaded cement spacers (ACSs). Reports of ACS-induced nephrotoxicity have raised concern regarding systemic absorption of antibiotics after ACS placement. We sought to characterize the serum concentrations of antibiotics that occur after ACS placement.
We performed a prospective study of patients with an infected primary total hip (THA) or knee arthroplasty (TKA) treated with standardized ACSs with vancomycin, gentamicin, and tobramycin. Serum antibiotic levels were collected weekly for 8 weeks.
Twenty-one patients (10 THA, 11 TKA) were included. Mean serum gentamicin levels ranged between 0.275±0.046 and 0.364±0.163 mg/L; mean serum tobramycin levels ranged from 0.313±0.207 to 0.527±0.424 mg/L; and mean serum vancomycin levels ranged from 5.46±6.6 to 15.34±9.6 mg/L. Serum antibiotic levels were detectable throughout the 8-week duration of ACS treatment. Regression analysis found that diabetes (coefficient 6.73, 95% CI 0.92-12.54, P < .05), blood urea nitrogen (coefficient 0.83, 95% CI 0.45-1.22, P < .001), number of cement doses (coefficient 3.71, 95% CI 0.76-6.66, P < .05), and use of systemic vancomycin (coefficient 6.24, 95% CI 2.72-9.75, P < .001) correlated with serum vancomycin levels. Patient age (coefficient -0.01, 95% CI -0.02 to 0, P < .01) and male sex (coefficient 0.20, 95% CI 0-0.41, P < .05) correlated with serum aminoglycoside level.
Systemic absorption of antibiotics from high-dose ACS persists for at least 8 weeks. Patients should be monitored closely for complications related to systemic absorption of antibiotics from ACS treatment.
二期治疗假体周围关节感染涉及高剂量抗生素载药水泥间隔物（ACS）的放置。ACS 引起肾毒性的报道引起了人们对 ACS 放置后抗生素全身吸收的关注。我们试图描述 ACS 放置后发生的抗生素血清浓度。
我们对接受标准化万古霉素、庆大霉素和妥布霉素 ACS 治疗的感染性初次全髋关节置换术（THA）或膝关节置换术（TKA）患者进行了前瞻性研究。每周采集血清抗生素水平，共 8 周。
共纳入 21 例患者（10 例 THA，11 例 TKA）。庆大霉素血清平均浓度范围为 0.275±0.046 至 0.364±0.163mg/L；妥布霉素血清平均浓度范围为 0.313±0.207 至 0.527±0.424mg/L；万古霉素血清平均浓度范围为 5.46±6.6 至 15.34±9.6mg/L。ACS 治疗期间整个 8 周均可检测到血清抗生素水平。回归分析发现，糖尿病（系数 6.73，95%CI 0.92-12.54，P <.05）、血尿素氮（系数 0.83，95%CI 0.45-1.22，P <.001）、水泥剂量（系数 3.71，95%CI 0.76-6.66，P <.05）和全身使用万古霉素（系数 6.24，95%CI 2.72-9.75，P <.001）与万古霉素血清水平相关。患者年龄（系数-0.01，95%CI-0.02 至 0，P <.01）和男性（系数 0.20，95%CI 0-0.41，P <.05）与血清氨基糖苷类水平相关。
ACS 中高剂量抗生素的全身吸收至少持续 8 周。应密切监测患者接受 ACS 治疗后与抗生素全身吸收相关的并发症。
