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Gentamicin serum concentrations in patients with gentamicin-PMMA beads for infected hip joints: a prospective

Paul A G de Klaver1, Johannes G E Hendriks, Hein A W van Onzenoort

  • 1Department of Clinical Pharmacy, Máxima Medical Center, Veldhoven, The Netherlands. pag.de.klaver@sjgweert.nl

Therapeutic Drug Monitoring
|January 18, 2012
PubMed
Abstract

Insights

Measurable gentamicin serum concentrations, exceeding 0.4 mg/L, were detected in patients with gentamicin-polymethylmethacrylate (PMMA) beads for infected hip joints. These elevated levels are linked to increased risk of nephrotoxicity.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Gentamicin-polymethylmethacrylate (PMMA) beads offer localized antibiotic delivery for infected hip joints.
  • Systemic gentamicin absorption and potential toxicity from these beads remain incompletely understood.
  • Quantifying gentamicin serum levels and associated nephrotoxicity is crucial for patient safety.

Purpose of the Study:

  • To determine the frequency of measurable gentamicin serum concentrations after gentamicin-PMMA bead implantation.
  • To assess the incidence of nephrotoxicity in patients receiving these beads.
  • To investigate the correlation between gentamicin serum levels and kidney damage.

Main Methods:

  • Observational cohort study involving 23 patients with infected hip joints treated with gentamicin-PMMA beads.
  • Serum samples analyzed for gentamicin and creatinine using standard and adjusted immunoassays (LLOQ 0.4 mg/L and 0.05 mg/L).
  • Nephrotoxicity defined by serum creatinine increase (>44 μmole/L and/or >25% relative increase).

Main Results:

  • Gentamicin serum concentrations >0.4 mg/L were found in 22% of patients after initial implantation and 26% of all samples.
  • Using a lower detection limit, 91% of samples showed measurable gentamicin levels (>0.05 mg/L).
  • Nephrotoxicity occurred more frequently (57% vs. 43%) in patients with measurable gentamicin serum concentrations (P = 0.02).

Conclusions:

  • Gentamicin serum concentrations above 0.4 mg/L are detectable in patients with gentamicin-PMMA beads for infected hip joints.
  • Elevated gentamicin serum levels (>0.4 mg/L) are associated with an increased risk of nephrotoxicity.
  • The number of implanted beads did not correlate with gentamicin levels or nephrotoxicity.

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