The effect of intraoperative autotransfusion on antibiotic pharmacokinetics during elective abdominal aortic aneurysm repair

Aim: Blood loss during aortic surgery has been reduced by the use of cell-s alvage techniques (CS), Antibiotics are used routinely to prevent prostheti c graft infection. The influence of CS on antibiotic levels is unknown. Thi s study measured antibiotic levels in serum and cell-salvage fluid during a ortic reconstruction. Methods: Teicoplanin, a glycopeptide with activity against Gram positive ba cteria was the antibiotic studied, Serial blood levels were measured after a single intravenous dose (400 mg) in five patients undergoing elective aor tic aneurysm repair. Patient ages ranged from 67 to 82 yr. Cell-salvage (Di deco compact A75171) fluid was also assayed. Setting: District General Hospital Results: Serum teicoplanin levels peaked at mean 67.8 mg/l (SD 8.9 mg/l) 5 min after administration, and fell to mean 2.88 mg/l (SD 0.4 mg/l) at 720 m in. This is less than levels in healthy volunteers but above the MIC90 for most Gram positive bacterial pathogens encountered in aortic surgery. Teico planin levels in discarded CS fluid at the end of the procedure were 0.56 m g/l (SD 0.71 mg/l). Conclusions: Teicoplanin blood levels are reduced during aortic surgery. Le vels remain adequate for antibacterial prophylaxis for 12 h postoperatively other than for methicillin-resistant staphylococcus epidermidis (MRSE). Co mpared with patients undergoing arterial reconstruction without the use of a cell-salvage device there is no significant loss due to CS use. (C) 2000 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd, All rights reserved.