Acute Kidney Injury because of Implanted Tobramycin Pellets: A Case Report

Area of Science:

• Nephrology
• Pharmacokinetics
• Bone Infections

Background:

• Fracture-related infections require targeted antibiotic treatment.
• Intraosseous administration of antibiotics can be effective for localized infections.
• Tobramycin is an aminoglycoside antibiotic with known nephrotoxic potential.

Observation:

• A 50-year-old male received 2.5 times the intended dose of tobramycin pellets during surgery for fracture-related infection.
• The patient developed acute kidney failure secondary to the supratherapeutic tobramycin dose.
• Intraosseous administration led to absorption-dependent pharmacokinetics and required multiple hemodialysis treatments.

Findings:

• Supratherapeutic doses of tobramycin pellets can cause significant nephrotoxicity.
• Despite the high dose and acute kidney injury, the nephrotoxicity was reversible.
• Hemodialysis was effective in managing tobramycin toxicity in this context.

Implications:

• This case demonstrates the potential for reversible kidney damage from high-dose intraosseous tobramycin.
• It underscores the importance of careful dosing and monitoring for aminoglycoside antibiotics, even with localized delivery.
• Recovery of renal function suggests that timely and aggressive supportive care, including hemodialysis, can mitigate severe outcomes.