Hidden Antimicrobials in Surgical Patients: Usage and Documentation of Antimicrobial Content of Bone Cement

Abstract

Specific Aims: To evaluate surgery, infectious disease, and nephrology consult documentation of antimicrobial content in bone cement within 30 days post-surgery; evaluate documentation of antimicrobial cement content by pharmacists in pharmacokinetic drug level evaluations within 6 months post-surgery; assess frequency and severity of adverse drug events associated with antimicrobials in bone cement. Methods: Retrospective chart review, which utilized a data collection form to evaluate the dose and type of antimicrobial agents prescribed, median and range antimicrobial doses per 40 grams of cement, documentation rates of antimicrobial content in clinical notes and incidence of potential adverse drug effects. Subjects were identified based on an ICD-9 code and their electronic medical records were accessed. Main Results: The sample size was 24 patients. The surgery notes had the highest rates of documentation with 96% naming the drug and 75% included the dose. The rates were the same in the infectious diseases consults and pharmacy pharmacokinetics notes with the drug name at 27% and the dose at 9%. No nephrology consult notes mentioned antimicrobials contained in the cement. Renal dysfunction (sCr≥2) developed in 13% of patients within 30 days and 25% of patients within 100 days. Approximately 17% of patients with renal dysfunction had the antimicrobial-laden cement removed. Conclusions: A variety of antimicrobial agents were embedded in bone cement at various concentrations and documentation from multiple sources was inconsistent. Likewise, adverse events associated with antimicrobial containing bone cement are not consistent.