Intra-articular implantation of gentamicin impregnated collagen sponge causes joint inflammation and impaired renal function in dogs

Summary

Objective: Gentamicin impregnated collagen sponge (GICS) can be used to treat intra-articular surgical site infections. High local concentrations of gentamicin can be reached for short periods; however the collagen vehicle may persist for much longer periods. We wished to determine the effect of sponge implantation on joint inflammation and renal function.

Methods: Eighteen medium sized mixed breed research dogs of hound type were randomized to two groups; arthroscopic implantation of GICS at gentamicin dose = 6 mg/kg (n = 9) or sham operation (n = 9). Endpoints consisted of joint inflammation measured by synovial fluid cell counts and cytokine concentrations; lameness measured by force plate asymmetry indices; and renal function measured by glomerular filtration rate (GFR) study. The prevalence of lesions associated with aminoglycoside nephrotoxicity was assessed by renal biopsy and transmission electron microscopy.

Results: Gentamicin impregnated collagen sponge implantation caused joint inflammation (p <0.01), lameness (p = 0.04), and decreased GFR (p = 0.04). No difference was observed in the prevalence of renal lesions on biopsy between the treatment and control groups (p = 0.49).

Clinical significance: Gentamicin impregnated collagen sponge implantation causes joint inflammation and lameness as well as GFR reductions at the dose assessed. Gentamicin impregnated collagen sponge are not recommended for intra-articular implantation in dogs.

Keywords

Gentamicin - collagen - sponge - dogs

• References

• 1 Bennett-Guerrero E, Pappas TN, Koltun WA. et al. Gentamicin-collagen sponge for infection prophylaxis in colorectal Surgery. N Engl J Med 2010; 363: 1038-1049.
• 2 Attmanspacher W, Dittrich V, Schätzler A. et al. [Mid-term outcome of postoperative infections of the shoulder][Article in German]. Unfallchirurg 2000; 103: 1048-1056.
• 3 Swieringa AJ, Goosen JH, Jansman FG. et al. In vivo pharmacokinetics of a gentamicin-loaded collagen sponge in acute periprosthetic infections: serum values in 19 patients. Acta Orthop 2008; 79: 637-642.
• 4 Schimmer C, Özkur M, Sinha B. et al. Gentamicin-collagen sponge reduces sternal wound complications after heart surgery: A controlled, prospectively randomized, double-blind study. J Thorac Cardiovasc Surg 2012; 143: 194-200.
• 5 Chaudhary S, Sen RK, Saini UC. et al. Use of gentamicin loaded collagen sponge in internal fixation of open fractures. Chin J Traumatol 2011; 14: 209-214.
• 6 Diefenbeck M, Muckley T, Hofmann GO. Prophylaxis and treatment of implant-related infections by local application of antibiotics. Injury 2006; 37 (Suppl. 02) Suppl S95-104.
• 7 Hayes GM, Gibson TW, Moens NM. et al. Intra-articular pharmacokinetics of a gentamicin impregnated collagen sponge in the canine stifle: an experimental study. Vet Surg 2014; 43: 166-173.
• 8 Mehta S, Humprey JS, Schenkman I D. et al. Gentamicin distribution from a collagen carrier. J Orthop Res 1996; 14: 749-754.
• 9 Kilian O, Hossain H, Flesch I. et al. Elution kinetics, antimicrobial efficacy, and degradation and microvasculature of a new gentamicin-loaded collagen fleece. J Biomed Mater Res Part B Appl Biomater 2009; 90: 210-222.
• 10 Swieringa AJ, Tulp NJ. Toxic serum gentamicin levels after the use of gentamicin-loaded sponges in infected total hip arthroplasty. Acta Orthop 2005; 76: 75-77.
• 11 Feldsien JD, Wilke VL, Evans RB. et al. Serum cortisol concentration and force plate analysis in the assessment of pain associated with sodium urate-induced acute synovitis in dogs. Am J Vet Res 2010; 71: 940-945.
• 12 Fitzpatrick N, Smith TJ, Evans RB. et al. Radiographic and arthroscopic findings in the elbow joints of 263 dogs with medial coronoid disease. Vet Surg 2009; 38: 213-223.
• 13 Fanchon L, Grandjean D. Accuracy of asymmetry indices of ground reaction forces for diagnosis of hind limb lameness in dogs. Am J Vet Res 2007; 68: 1089-1094.
• 14 Von Hendy-Willson VE, Pressler BM. An overview of glomerular filtration rate testing in dogs and cats. Vet J 2011; 188: 156-165.
• 15 Rougier F, Claude D, Maurin M. et al. Aminoglycoside nephrotoxicity. Current Drug Targets - Infectious Disorders 2004; 4: 153-162.
• 16 Bennett-Guerro E, Pappas TN, Koltun WA. et al. Gentamicin collagen sponge for infection prophylaxis in colorectal surgery. N Engl J Med 2010; 363: 1038-1049.