Penetration of antibiotics into decubitus ulcers

Berger, Stephen A.; Barza, Michael; Haher, Jane N.; Bell, Diana; Waintraub, Stanley; Burtyk, Mary L.; Kane, Anne

doi:10.1093/jac/7.2.193

Cited by 17 publications

(3 citation statements)

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“…This is not necessarily an unexpected finding. In one study, cefazolin was not detected in the debrided tissues of decubitus ulcers (2). The clinical implications of these findings remain to be explored.…”

Section: Discussionmentioning

confidence: 96%

Irrigation-aspiration for culturing draining decubitus ulcers: correlation of bacteriological findings with a clinical inflammatory scoring index

Ehrenkranz¹,

Alfonso²,

Nerenberg³

1990

J Clin Microbiol

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Biopsy of infected decubitus ulcers for culture disrupts tissues and may disseminate infection. Antimicrobial prophylaxis to prevent dissemination of infection may adversely affect biopsy culture results. Irrigationaspiration to obtain submarginal specimens from draining decubitus ulcers was studied as an atraumatic, noninvasive culturing technique to serve as an alternative to biopsy in research activities. Two aspirates were obtained serially from 32 subjects; in 12 subjects, biopsies were also performed immediately. A median of 4.5 bacterial species was recovered per ulcer by irrigation-aspiration. Recent antimicrobial treatment had no evident effect on the recovery of bacterial species in general or, specifically, on the recovery of Bacteroides species. Concordance of results for both aspirates was 97.6% for aerobes and 91.8% for anaerobes, indicating no interactive methodological effect of the first irrigation-aspiration on the second. Compared with biopsy isolates for one aspirate, the sensitivity was 93% and the specificity was 99.0%; for another aspirate, the sensitivity was 94.7% afid the specificity was 99.5%. The positive predictive value for either aspirate was .93.9%. A weighted clinical index to score inflammatory ulcer characteristics was devised (score range, 0 to 15). In the absence of anaerobes in 15 subjects, the mean score was 6.1 ± 3.5; in the presence of anaerobes in 17 subjects, the mean score was 9.4 ± 3.2 (P = 0.008). The presence of aerobic gram-positive or gram-negative species did not significantly affect scores. Irrigation-aspiration for culture and clinical scoring of inflammation should permit independent serial measures of bacteriological and clinical courses of draining decubitus ulcers without patient risk or discomfort.

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Section: Discussionmentioning

confidence: 96%

Irrigation-aspiration for culturing draining decubitus ulcers: correlation of bacteriological findings with a clinical inflammatory scoring index

Ehrenkranz¹,

Alfonso²,

Nerenberg³

1990

J Clin Microbiol

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“…Whether this holds true in human subjects, in whom the above-mentioned changes in paralyzed tissues may be exaggerated, remains to be answered; unlike mice, patients with spinal cord injury survive for months to years after the insult, have a relatively larger leg size, and are usually bedridden. Moreover, antibiotics belonging to other classes may penetrate tissues differently (1,8,13). Further studies will help determine whether the current antibiotic regimens used to treat certain infections in the general population should be adapted for soft tissue infections in paralyzed subjects.…”

Section: Discussionmentioning

confidence: 99%

Cephalosporin penetration into soft tissue of paralyzed limbs

Darouiche

Musher

Hamill

et al. 1989

Antimicrob Agents Chemother

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Poor penetration of antibiotics into paralyzed tissue may contribute to the difficulty of curing soft tissue infections in paralyzed limbs. A novel model of spinal cord hemisection was used to induce paralysis of one hind leg in mice. Five, 10, or 20 days after induction of paralysis, six groups of 10 mice were injected intravenously with a single dose or with four sequential doses of cefepime, a new broad-spectrum cephalosporin, and then sacrificed. High-performance liquid chromatography was used to compare cefepime levels in soft tissue homogenates of paralyzed and normal hind legs; no significant differences were found in any group. Factors other than antibiotic delivery may be responsible for difficulty in curing infections in paralyzed soft tissue.Soft tissue infections frequently occur in patients with spinal cord injury and are difficult to treat (5,17,18). Reduced delivery of antibiotics to paralyzed tissue could be responsible, although local factors may also play a role (11). We elected to investigate the effect of paralysis on antibiotic distribution by developing a hitherto undescribed mouse model that caused unilateral paralysis of one hind leg. By using high-performance liquid chromatography, we measured the concentration of cefepime, a new broad-spectrum cephalosporin, in soft tissue homogenates, comparing in each mouse the paralyzed limb with the normal limb. MATERIALS AND METHODSAnimals. Swiss albino Sprague-Dawley mice (approximate weight, 30 g) were used. Mice were anesthetized with methoxyflurane (Pitman-Moore Inc., Washington Crossing, N.J.), and a 0.5-cm incision was made over the midthoracic spine of each mouse. A #15 scalpel blade was gently introduced posterolaterally through soft tissue into the vertebral column. The scalpel was aimed medially to achieve hemisection of the spinal cord. Unilateral paralysis of one hind leg occurred in nearly one-half of the mice; approximately one-third of these animals regained function in the paralyzed leg within a few days, and these were excluded from the study. Cages were modified to provide easy access to food and water.Experimental design. Five, 10, or 20 days after induction of paralysis, groups of 10 mice each were injected intravenously with a single dose, or with four doses at 1-h intervals, of 200 mg of cefepime (Bristol-Myers Company, Wallingford, Conn.) per kg. A pilot study had shown that the serum half-life of cefepime in mice was about 17 min. At 1 h after the last cefepime dose, mice were anesthetized and sacrificed by aspirating as much blood as possible via a cardiac puncture. The heart and great vessels were then severed in order to minimize blood in the peripheral tissue. After removing overlying skin and subcutaneous tissues, both hind legs were resected, rinsed to remove adhering blood, and blotted dry. The soft tissue, which consisted largely of muscle, was dissected from bone, minced, weighed, and placed in polypropylene tubes (17 by 100 mm). Phosphatebuffered saline was added in a volume:weight ratio of 3:1. * Corresponding aut...

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“…Although penetration of antibiotics into living tissue has been extensively studied (3,4,18), measurement of antibiotic concentrations in viable tissue surrounding pressure * Corresponding author. sores in patients with SCI has not been described.…”

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confidence: 99%