Ferencz J R, Assia E I, Diamantstein L, Rubinstein E
Department of Ophthalmology, Meir Hospital, Sapir Medical Center, Kfar-Saba, Israel.
Arch Ophthalmol. 1999 Aug;117(8):1023-7. doi: 10.1001/archopht.117.8.1023.
To measure the concentrations of vancomycin in the vitreous of patients with postoperative endophthalmitis after administration of 1 g of vancomycin hydrochloride intravenously and injection of 1 mg of vancomycin hydrochloride into the vitreous, and to determine whether these concentrations are adequate for treatment of gram-positive infections.
Patients with acute postoperative endophthalmitis were treated with intravenous administration of 1 g of vancomycin hydrochloride followed by vitrectomy and collection of vitreous samples 1 to 5 hours later. Intravitreal vancomycin and ceftazidime were given. Vitreous samples were cultured and their vancomycin concentrations assayed. Minimal inhibitory concentrations of vancomycin for the isolated vitreal pathogens, and serum and vitreous cidal activity were determined.
Eighteen patients with acute postoperative endophthalmitis were studied. Fourteen vitreous samples were available after intravenous vancomycin administration, and 4 vitreous samples were available after intravitreal vancomycin administration. After intravenous injection, vitreous vancomycin concentrations ranged from 0.4 to 4.5 microg/mL. Minimal inhibitory concentrations in these samples, obtained from 10 bacterial isolates, were below the therapeutic levels for most causative organisms, including staphylococci. Vitreous cidal activity values were negative at a dilution of 1:2 in 9 of 10 patients examined. After a 1-mg intravitreal injection, vancomycin concentrations in vitreous samples obtained by a second tap from 4 patients 44 to 72 hours later were 182, 138, 58, and 25 microg/mL. In 2 patients in whom measurements were obtained, vitreous cidal activity values were 1:512 and 1:32.
Vitreous vancomycin concentrations for the treatment of gram-positive endophthalmitis were nontherapeutic after intravenous administration but therapeutic after intravitreal administration.
在静脉注射1g盐酸万古霉素并向玻璃体腔内注射1mg盐酸万古霉素后，测量术后眼内炎患者玻璃体中万古霉素的浓度，并确定这些浓度是否足以治疗革兰氏阳性菌感染。
急性术后眼内炎患者先接受静脉注射1g盐酸万古霉素治疗，随后进行玻璃体切除术，并在1至5小时后采集玻璃体样本。同时给予玻璃体腔内注射万古霉素和头孢他啶。对玻璃体样本进行培养并测定其中万古霉素的浓度。确定万古霉素对分离出的玻璃体病原体的最低抑菌浓度以及血清和玻璃体的杀菌活性。
对18例急性术后眼内炎患者进行了研究。静脉注射万古霉素后获得了14份玻璃体样本，玻璃体腔内注射万古霉素后获得了4份玻璃体样本。静脉注射后，玻璃体中万古霉素浓度范围为0.4至4.5μg/mL。从10株细菌分离株获得的这些样本中的最低抑菌浓度，对于包括葡萄球菌在内的大多数病原体而言低于治疗水平。在10例接受检查的患者中，有9例在1:2稀释度时玻璃体杀菌活性值为阴性。在玻璃体腔内注射1mg万古霉素后，44至72小时后从4例患者第二次抽取的玻璃体样本中万古霉素浓度分别为182、138、58和25μg/mL。在2例进行了测量的患者中，玻璃体杀菌活性值分别为1:512和1:32。
静脉注射后，用于治疗革兰氏阳性菌性眼内炎的玻璃体万古霉素浓度未达到治疗水平，但玻璃体腔内注射后则达到了治疗水平。
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