Bayer A S, Crowell D J, Yih J, Bradley D W, Norman D C
Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance 90509.
J Infect Dis. 1988 Aug;158(2):355-9. doi: 10.1093/infdis/158.2.355.
A factor in the higher medical cure rates for endocarditis in the right as opposed to the left side of the heart in humans may be a difference in antimicrobial pharmacokinetics within vegetations. Rabbits with combined tricuspid and aortic endocarditis due to Pseudomonas aeruginosa received single intravenous doses of either ceftazidime (50 mg/kg) or amikacin (15 or 40 mg/kg). For each antibiotic regimen, areas under the time-concentration curves and percent vegetation penetrances were significantly greater for tricuspid than aortic vegetations (P less than .001). Time-concentration curves for aortic vegetations paralleled those for plasma; curves for the tricuspid vegetations resembled those for subcutaneous fibrin clots. The times above the minimum bactericidal concentration for tricuspid vegetations were significantly longer than those achieved within aortic vegetations for ceftazidime (P less than .01) and amikacin at 15 mg/kg (P less than .001). Antimicrobial pharmacokinetics and pharmacodynamics may be more favorable within tricuspid than aortic vegetations; this difference may, in part, explain more salutary outcomes in bacterial endocarditis involving the right side of the heart.
人类心内膜炎右侧的治愈率高于左侧，其中一个因素可能是赘生物内抗菌药物的药代动力学存在差异。患有铜绿假单胞菌所致三尖瓣和主动脉瓣联合心内膜炎的兔子接受了单次静脉注射头孢他啶（50mg/kg）或阿米卡星（15或40mg/kg）。对于每种抗生素治疗方案，三尖瓣赘生物的时间-浓度曲线下面积和植被穿透百分比均显著高于主动脉赘生物（P<0.001）。主动脉赘生物的时间-浓度曲线与血浆相似；三尖瓣赘生物的曲线类似于皮下纤维蛋白凝块的曲线。三尖瓣赘生物高于最低杀菌浓度的时间显著长于头孢他啶（P<0.01）和15mg/kg阿米卡星在主动脉赘生物内达到的时间（P<0.001）。三尖瓣赘生物内的抗菌药物药代动力学和药效学可能比主动脉赘生物更有利；这种差异可能部分解释了累及心脏右侧的细菌性心内膜炎更有益的结果。
