A case report of acute interstitial nephritis associated with antibiotic-impregnated orthopedic bone-cement spacer

Local antibiotics are effective adjunct therapy for the treatment of orthopedic infections and antibiotic loaded bone cement is successfully used in revision procedures of infected hip and knee arthroplasties. Different antibiotics in isolation or in combination can be added into bone cement. The theory behind the use of antibiotic loaded cement is that anti-infective drug incorporated into the cement diffuses into surrounding tissues over a period of weeks to months, thereby providing prolonged high local concentration of antibiotic while minimizing systemic drug toxicities. Although kidney toxicity due to acute tubular necrosis has been previously described, we report for the first time a case of a 58-year-old male who developed acute kidney injury clinically consistent with acute interstitial nephritis, after undergoing revision treatment for septic knee arthritis with the use of cement spacer impregnated with a combination of vancomycin and tobramycin.