Ristuccia A M, Gayle W E, Wasserman A J, Cunha B A
J Trauma. 1982 Nov;22(11):944-9. doi: 10.1097/00005373-198211000-00010.
This study was originated in recognition that little data have been accumulated in the literature regarding concentrations of gentamicin in various infected tissues. The study was undertaken to determine if systemically administered gentamicin penetrates burn wound eschar and to determine if there is a relationship between gentamicin serum levels attained and concentration of gentamicin reaching the eschar. Five hospitalized adult patients requiring parenteral gentamicin for sepsis secondary to third-degree burns were studied prospectively. For the purpose of determining the amount of gentamicin reaching the eschar, biopsy of the burn wound eschar was performed on each patient. Venous blood samples were also obtained to examine the relationship of serial serum samples to eschar levels. Calculated pharmacokinetic parameters include elimination rate constants, apparent volume of distribution, beta, and gentamicin half-life. The data indicate that systemically administered gentamicin does penetrate burn eschar in measurable quantities. Deeper layers of eschar tissue contained significantly greater quantities of gentamicin. Analysis of variance resulted in statistically significant (p less than 0.05) rise is eschar concentration with time. A positive correlation between the peak serum gentamicin concentration and the concentration of gentamicin reaching the burn tissue was found. The quantity of gentamicin attained was sufficient to prevent proliferation of organisms cultured from the eschar of patients. Accumulation of gentamicin in the eschar occurred in every patient studied. This study suggests the eradication of organisms in eschar samples is due to the achievable concentration of gentamicin at this site.
本研究源于认识到文献中关于庆大霉素在各种感染组织中的浓度积累的数据很少。该研究旨在确定全身给药的庆大霉素是否能穿透烧伤创面焦痂，并确定所达到的庆大霉素血清水平与到达焦痂的庆大霉素浓度之间是否存在关系。对五名因三度烧伤继发败血症而需要胃肠外使用庆大霉素的住院成年患者进行了前瞻性研究。为了确定到达焦痂的庆大霉素量，对每位患者的烧伤创面焦痂进行了活检。还采集了静脉血样，以检查系列血清样本与焦痂水平之间的关系。计算的药代动力学参数包括消除速率常数、表观分布容积、β和庆大霉素半衰期。数据表明，全身给药的庆大霉素确实能以可测量的量穿透烧伤焦痂。焦痂组织的深层含有明显更多的庆大霉素。方差分析导致焦痂浓度随时间有统计学显著升高（p小于0.05）。发现血清庆大霉素峰值浓度与到达烧伤组织的庆大霉素浓度之间呈正相关。所达到的庆大霉素量足以防止从患者焦痂培养的生物体增殖。在每个研究的患者中，庆大霉素都在焦痂中积累。这项研究表明，焦痂样本中生物体的根除是由于该部位可达到的庆大霉素浓度。
