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

Josefine Windfeld-Mathiasen1, Henrik Horwitz1,2, Frederik Schwartz3

  • 1Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.

JBJS Case Connector
|April 7, 2023
PubMed
Abstract

Insights

A patient experienced acute kidney failure after a supratherapeutic dose of tobramycin pellets but fully recovered after hemodialysis. This case highlights the reversible nephrotoxicity of tobramycin, even at high doses.

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.

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