Acute kidney failure after intra-articular use of gentamicin sponge

Area of Science:

• Nephrology
• Orthopedic Surgery
• Infectious Disease

Background:

• Periprosthetic joint infections require effective treatment strategies.
• Gentamicin is an aminoglycoside antibiotic with known nephrotoxic potential.
• Intra-articular application of gentamicin sponges is used for localized antibiotic delivery.

Observation:

• An 83-year-old male patient presented with acute kidney failure.
• The patient had recently undergone intra-articular administration of gentamicin sponges for a periprosthetic hip infection.

Findings:

• The patient's acute kidney failure was attributed to gentamicin exposure from the sponges.
• Hemodialysis was required for both gentamicin clearance and renal function support.
• Serum creatinine levels indicated significant nephrotoxicity.

Implications:

• Clinicians must recognize the risk of systemic gentamicin absorption and subsequent renal toxicity from intra-articular sponges, particularly in elderly patients.
• Careful patient selection and monitoring are crucial when using gentamicin sponges for localized infections.
• Alternative or adjunctive strategies may be considered to mitigate nephrotoxicity risk.