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Acute kidney failure and lack of efficacy: case report An 83-year-old woman developed acute renal failure during treatment with gentamicin for multi-resistant pseudomonas aeruginosa infected total knee arthroplasty (TKA). Additionally, she exhibited a lack of efficacy with cefepime and ceftazidime, while being treated for a multi-resistant pseudomonas aeruginosa infection [dosages not stated; not all routes stated]. The woman, who had undergone a TKA surgery, was admitted with painful left knee, wound dehiscence and joint swelling. The microbiological analysis revealed a multi-resistant pseudomonas aeruginosa infection. Subsequently, she started receiving treatment with oral ceftazidime and IV cefepime; however, no local and laboratory parameters improvement were observed with relapsed in symptoms following two weeks of hospitalisation (lack of efficacy). Subsequently, she had undergone a TKA removal and gentamicin-impregnated cement spacer implantation (0.5g per 40g batch) [Refobacin bone cement R; BIOMET INC]. Following the initial general and local improvement, after three days, her clinical status had progressively deteriorated. She reported confusion, nausea, weakness, irregular heartbeat, shortness of breath and fatigue. Investigations revealed decreased levels of haemoglobin and urine output and increased levels of CRP, serum creatinine (SCr) and blood urea nitrogen (BUN). Following next 5 days, her SCr and BUN continued to rise in spite of the administration of unspecified diuretics and modulation of an adequate fluid therapy. Despite a low serum level of gentamicin, nephrotoxicity associated with gentamicin was suspected. The woman’s gentamicin impregnated spacer was removed the day after, and her knee was stabilised using an arthrodesis with an external fixator. Subsequently, she was admitted to the ICU for 7 days, before she returned to the orthopaedic department, when her acute renal failure had resolved. Based on these clinical presentation and findings a confirm diagnosis of acute renal failure associated with gentamicin was made. The SCr and BUN values normalised in about 30 days after the removal of spacer. One year later, the external fixator was removed. After 3 years, during the last follow up she continued to be asymptomatic, and returned to her daily activity. Mazza D, et al. Acute kidney failure after total knee arthroplasty revision with antibiotic-impregnated cement spacer. Orthopedic Reviews 12: 87-89, No. 2, 2020. Available 803502127 from: URL: http://doi.org/10.4081/or.2020.8540

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Reactions 19 Sep 2020 No. 1822