Pargas Carlos D, Elhessy Ahmed H, Abouei Mehdi, Gesheff Martin G, Conway Janet D
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA.
Antibiotics (Basel). 2022 Mar 4;11(3):336. doi: 10.3390/antibiotics11030336.
Local antibiotic delivery using different carriers plays an important role in both infection prophylaxis and treatment. Besides dead space management, these carriers have the advantage of providing a high concentration of local antibiotics with a lower risk of systemic toxicity. Few studies have reported on systemic toxicity associated with antibiotic-impregnated carriers. The present study investigates the systemic tobramycin concentration at 24, 48 and 72 h postoperatively after using tobramycin-loaded polymethyl methacrylate (PMMA) and calcium sulfate (CS) as local antibiotic carriers. Additionally, this work assesses the renal function postoperatively for indications of acute kidney injury (AKI). Fifty-two patients were treated in 58 procedures with tobramycin and vancomycin-loaded PMMA, CS, or both. All systemic tobramycin levels were <2 mcg/mL at 72 h, and the resulting rate of AKI was 12% (7/58). In conclusion, local tobramycin antibiotic delivery using PMMA, CS, or both remains a safe and effective modality in the treatment of osteomyelitis as long as the surgeon is aware of its possible nephrotoxic effect.
使用不同载体进行局部抗生素递送在感染预防和治疗中均发挥着重要作用。除了死腔管理外，这些载体还具有能提供高浓度局部抗生素且全身毒性风险较低的优势。很少有研究报道与抗生素浸渍载体相关的全身毒性。本研究调查了使用载有妥布霉素的聚甲基丙烯酸甲酯（PMMA）和硫酸钙（CS）作为局部抗生素载体术后24、48和72小时的全身妥布霉素浓度。此外，这项工作评估了术后肾功能以寻找急性肾损伤（AKI）的迹象。52例患者接受了58次使用载有妥布霉素和万古霉素的PMMA、CS或两者的手术。所有全身妥布霉素水平在72小时时均<2 mcg/mL，由此产生的AKI发生率为12%（7/58）。总之，只要外科医生意识到其可能的肾毒性作用，使用PMMA、CS或两者进行局部妥布霉素抗生素递送在骨髓炎治疗中仍然是一种安全有效的方法。
