TEICOPLANIN CONCENTRATIONS IN SERUM, PERICARDIUM, PERICARDIAL FLUID AND THORACIC WALL FAT IN PATIENTS UNDERGOING CARDIOPULMONARY BYPASS-SURGERY

The concentrations of teicoplanin in serum, pericardium, pericardial f luid and thoracic wall fat were measured in patients undergoing cardio -pulmonary bypass (CPB) after the administration of a single iv 12 mg/ kg dose. Five minutes after the start of CPB, teicoplanin serum concen trations decreased by, on average, 35% (95% confidence interval (CI): 28-42%) and remained significantly lower than the expected values over the subsequent 60 min period. After aortic unclamping drug concentrat ions rebounded but remained significantly lower than the expected valu es in the next 60 min. Immediately before CPB, penetration of teicopla nin in pericardium and thoracic wall fat was 0.44 (95% CI: 0.23-0.65) and 0.05 (95% CI: 0.03-0.7), respectively, and increased at the end of CPB to 0.90 (95% CI: 0.55-1.25) and 0.17 (95% CI: 0.05-0.29), respect ively. MICs for most staphylococcal strains were attained during CPB p rocedure in pericardium but not in thoracic wall fat. However, since s taphylococcal infections involve the interstitial space it is likely t hat penetration into fat cells is not important for antimicrobial prop hylaxis. In this respect, it is worth noting that drug concentration i n pericardial fluid, which should reflect the interstitial concentrati on, was higher than the MIC for most staphylococcal strains. Although no infective complications were observed in our limited series of pati ents, larger clinical trials are needed to assess whether the dose reg imen employed is effective in preventing post-CPB surgery infections.