Factors associated with elevated serum gentamicin levels in hip and knee joints treated with continuous local
Masashi Shimoda1, Hyonmin Choe1, Yuta Hieda1
1Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
Background:
Continuous local antibiotic perfusion (CLAP) delivers high-concentration antibiotics locally to achieve the minimal biofilm eradication concentration. Although CLAP has shown efficacy in orthopaedic infections, data on serum gentamicin levels and associated complications remain limited. This study aimed to evaluate serum gentamicin elevation and related adverse events during CLAP, and to identify contributing factors.
Methods:
A retrospective review was conducted of 59 patients who underwent CLAP for hip or knee joints between 2019 and 2024, with perioperative serum gentamicin levels measured. Data included laboratory findings, CLAP duration, number of intra-soft tissue perfusion (iSAP) tubes and intra-medullary perfusion (iMAP) pins, gentamicin dose, peak serum gentamicin level, and adverse events.
Results:
Serum gentamicin levels exceeded 1.0 μg/mL in 21 patients (36 %). The median day of peak serum gentamicin level was 7 postoperative days (IQR, 3-10), most frequently on postoperative day (POD) 3 and POD 10. Acute kidney injury (AKI) occurred in 7 cases (12 %), with one requiring temporary dialysis. Renal function recovered in all cases after cessation of CLAP. No ototoxicity (cranial nerve VIII toxicity) was observed. A univariate analysis showed that a greater number of iMAP pins, longer CLAP duration, higher gentamicin doses, and abnormal preoperative laboratory values (including lower albumin and hemoglobin, and higher CRP, ESR, creatinine, and neutrophil counts) were associated with elevated serum gentamicin levels.
Conclusion:
Elevated serum gentamicin levels occurred in a subset of patients treated with CLAP. Elevated serum gentamicin levels may be associated with both treatment-related factors (iMAP pins, gentamicin dose, and CLAP duration) and host-related factors (lower albumin and hemoglobin, renal function, and systemic inflammation). Considering these risk factors may help adjust dosing strategies and contribute to the safe application of CLAP.
Insights
Continuous local antibiotic perfusion (CLAP) can lead to elevated serum gentamicin levels in some patients. Factors like device placement and patient health influence these levels, informing safer CLAP dosing strategies.
Area of Science:
- Orthopaedic surgery
- Infectious disease management
- Pharmacokinetics
Background:
- Continuous local antibiotic perfusion (CLAP) is effective for orthopaedic infections.
- Limited data exists on serum gentamicin levels and complications with CLAP.
- This study evaluates gentamicin levels, adverse events, and contributing factors during CLAP.
Purpose of the Study:
- To assess serum gentamicin levels in patients undergoing CLAP.
- To identify adverse events associated with elevated gentamicin levels.
- To determine factors contributing to increased serum gentamicin concentrations.
Main Methods:
- Retrospective review of 59 patients undergoing CLAP for hip/knee joints (2019-2024).
- Perioperative serum gentamicin levels were measured.
- Data collected included perfusion details, gentamicin dose, peak levels, and adverse events.
Main Results:
- 36% of patients had serum gentamicin levels >1.0 μg/mL.
- Peak levels often occurred around postoperative days 3 and 10.
- Acute kidney injury (AKI) occurred in 12% of patients, with full renal recovery.
Conclusions:
- Elevated serum gentamicin levels are observed in a subset of CLAP patients.
- Factors include treatment parameters (iMAP pins, dose, duration) and patient status (albumin, hemoglobin, inflammation).
- Identifying risk factors can optimize CLAP dosing for safety.
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