Friberg Orjan, Jones Ian, Sjöberg Lennart, Söderquist Bo, Vikerfors Thomas, Källman Jan
Department of Cardiothoracic Surgery, Orebro University Hospital, Orebro, Sweden.
Scand J Infect Dis. 2003;35(4):251-4. doi: 10.1080/003655400310000184.
One important aim of antibiotic prophylaxis in cardiac surgery is preventing mediastinitis and thus it would appear to be relevant to study the antibiotic concentrations in pericardial/mediastinal fluid. Local administration of gentamicin in the wound before sternal closure is a novel way of antibiotic prophylaxis and could be effective against bacteria resistant to intravenous antibiotics. This study measured dicloxacillin concentrations in 101 patients in serum and wound fluid following intravenous administration of dicloxacillin. Similarly, concentrations of gentamicin in serum and wound fluid were determined in 30 patients after administration of 260 mg gentamicin in the wound at sternal closure. Median dicloxacillin concentrations in serum and wound fluid at sternal closure were 59.4 and 55.35 mg/l, respectively. Gentamicin levels in the wound were very high (median 304 mg/l), whereas serum concentrations were low (peak median 2.05 mg/l). Dicloxacillin, 1 g given intravenously, according to the clinical protocol, resulted in levels in serum and wound fluid at sternal closure likely to prevent Staphylococcus aureus infections. Locally administered gentamicin resulted in high local concentrations, potentially effective against agents normally considered resistant.
心脏手术中抗生素预防的一个重要目标是预防纵隔炎，因此研究心包/纵隔液中的抗生素浓度似乎具有相关性。在胸骨闭合前于伤口局部应用庆大霉素是一种新型的抗生素预防方法，可能对耐静脉用抗生素的细菌有效。本研究测定了101例患者静脉注射双氯西林后血清和伤口液中的双氯西林浓度。同样，在30例患者胸骨闭合时于伤口应用260mg庆大霉素后，测定了血清和伤口液中的庆大霉素浓度。胸骨闭合时血清和伤口液中双氯西林的中位浓度分别为59.4mg/L和55.35mg/L。伤口中的庆大霉素水平非常高（中位值304mg/L），而血清浓度较低（峰值中位值2.05mg/L）。根据临床方案静脉给予1g双氯西林，在胸骨闭合时血清和伤口液中的水平可能预防金黄色葡萄球菌感染。局部应用庆大霉素导致局部高浓度，可能对通常认为耐药的病原体有效。
