The importance of tissue antibiotic activity in the prevention of operative wound infection

Bergamini, Thomas M.; Polk, Hiram C.

doi:10.1093/jac/23.3.301

Cited by 64 publications

(34 citation statements)

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“…These infectious complications illustrate the difficulties encountered by providing classical schemes of prophylactic antibiotherapy in new surgical fields such as liver transplantation without pharmacokinetic support. The real goal of prophylaxis is to reach and maintain blood and tissue drug concentrations at levels that allow the inhibition of growth of contaminating agents throughout the surgical procedure (2).…”

Section: Resultsmentioning

confidence: 99%

Concentrations in plasma and tissue penetration of ceftriaxone and ornidazole during liver transplantation

Steib

Jacoberger

Bandel

et al. 1993

Antimicrob Agents Chemother

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Plasma and epiploic fat drug concentrations and fat penetration of ceftriaxone and ornidazole given for antimicrobial prophylaxis were studied in 11 patients scheduled for liver transplantation. Ceftriaxone (1 g) and ornidazole (500 mg) were infused during 30 min after the induction of anesthesia. Arterial blood and epiploic fat samples were collected at 30, 60, and 120 min and then every 90 min following the end of the infusion until closure of the peritoneum. Blood samples were immediately centrifuged, and plasma and fat were stored at -35°C until analysis. Ceftriaxone and ornidazole concentrations were determined by high-performance liquid chromatography. Surgery lasted 440 + 84 min and required a mean of 9.5 units of packed erythrocytes and 13 units of fresh frozen plasma. Plasma ceftriaxone concentrations decreased from 89 ± 34 to 41 ± 16.5 ,ag/ml from the beginning of the operation until the time of closure of the peritoneum. Corresponding levels in epiploic fat decreased from 8.7 + 3.3 to 4.5 + 3.5 ag/g. Ornidazole concentrations ranged, respectively, between 8.7 + 2.5 and 4.9 ± 1.7 ,ug/ml in plasma samples and 4.6 ± 1.2 and 2.5 _ 1.1. ,g/g in fat samples. Rates of penetration into the omentum remained at about 9%o for ceftriaxone and between 50 and 70%o for ornidazole. Tissue ceftriaxone concentrations were, in all cases, greater than typical MICs for 90%o for Escherichia coli and KlebsieUla isolates tested (MIC90s). They were insufficient in 40o of patients after 60 min with regard to the MIC90s for Staphylococcus aureus. Tissue ornidazole concentrations were not superior to MIC,0s for anaerobes after 30 min in 50%o of patients. These results show that a single dose of 1 g of ceftriaxone provides adequate coverage against gram-negative bacteria and that 1 g instead of 500 mg of ornidazole may provide a protective effect against anaerobes during liver transplantation. Prophylaxis against S. aureus and Streptococcusfaecalis requires more specific antibiotics. Prophylaxis for patients with significant blood loss or initial severe renal or hepatic failure needs further evaluation.

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Section: Resultsmentioning

confidence: 99%

Concentrations in plasma and tissue penetration of ceftriaxone and ornidazole during liver transplantation

Steib

Jacoberger

Bandel

et al. 1993

Antimicrob Agents Chemother

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“…The antibiotic is administered some time before the operation to ensure sufficient concentrations in the tissues at the time of anticipated infection (Bergamini & Polk, 1989). Since little is known about the rate of diffusion of the antibiotic between plasma and tissues it is difficult to estimate the optimal timing of antibiotic administration.…”

Section: Introductionmentioning

confidence: 99%

Diffusion of cloxacillin into synovial tissue.

Mattie

Marie

Slaghuis

et al. 1992

Brit J Clinical Pharma

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After a 30 min i.v. infusion of 1 g cloxacillin, the concentrations of this antibiotic were measured in plasma and synovial tissue samples from 11 patients undergoing total hip replacement. Assuming passive distribution between plasma and tissue the rate constants of distribution were estimated. The mean half‐life of distribution was 22 min. The concentration of free drug in synovial tissue was estimated to be 77% of the total tissue concentration. The maximum tissue drug concentration after an i.v. bolus dose is predicted to occur at about 37 min.

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“…However, the problem of tissue distribution is often analyzed too simplistically, without consideration of the very different results obtained in relation to the various study methods, the different physicochemical drug parameters, the study population, and the type of result evaluation (1)(2)(3)(4). The presence of blood in tissues, the degree of inflammation, the different sampling methods, and the antibiotic dosage (chemical, biological, etc.)…”

mentioning

confidence: 99%

Penetration of cefotetan into suction skin blister fluid and tissue homogenates in patients undergoing abdominal surgery

Mazzei

Tonelli

Novelli

et al. 1994

Antimicrob Agents Chemother

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The penetration of cefotetan (2-g intravenous bolus) into the suction blister fluid and tissue homogenates of 11 patients was investigated. Mean concentrations in tissue were significantly lower than contemporary suction blister fluid levels. These data show that the determination of beta-lactam concentrations by the tissue homogenate method may seriously underestimate the actual antibiotic levels in extracellular fluid.

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The importance of tissue antibiotic activity in the prevention of operative wound infection

Cited by 64 publications

References 0 publications

Concentrations in plasma and tissue penetration of ceftriaxone and ornidazole during liver transplantation

Concentrations in plasma and tissue penetration of ceftriaxone and ornidazole during liver transplantation

Diffusion of cloxacillin into synovial tissue.

Penetration of cefotetan into suction skin blister fluid and tissue homogenates in patients undergoing abdominal surgery

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