Impaired target site penetration of β -lactams may account for therapeutic failure in patients with septic shock
| Autor: | Peter Siostrzonek, Markus Müller, Bernhard X. Mayer, Hans Georg Eichler, Martin Brunner, Nikolas Klein, Martin Frossard, Christian Joukhadar |
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| Rok vydání: | 2001 |
| Předmět: |
Male
Drug Pathology medicine.medical_specialty Time Factors medicine.drug_class Microdialysis media_common.quotation_subject medicine.medical_treatment Antibiotics Microbial Sensitivity Tests Pharmacology Critical Care and Intensive Care Medicine Drug Delivery Systems Interstitial space Pharmacokinetics Humans Medicine Tissue Distribution Prospective Studies Treatment Failure Infusions Intravenous Muscle Skeletal Chromatography High Pressure Liquid Aged media_common Antibacterial agent Piperacillin Chemotherapy business.industry Septic shock Middle Aged medicine.disease Shock Septic Anti-Bacterial Agents Adipose Tissue Case-Control Studies Practice Guidelines as Topic Female Drug Monitoring business medicine.drug |
| Zdroj: | Critical Care Medicine. 29:385-391 |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/00003246-200102000-00030 |
| Popis: | Current guidelines for adjusting antimicrobial therapy regimens commonly are based on drug concentrations measured in plasma. In septic patients, however, the interstitial space of soft tissues in addition to the central compartment represents the target site of infection. We thus hypothesized that one explanation for therapeutic failure during antibiotic treatment might be the inability to achieve effective antimicrobial concentrations in the interstitial space fluid of soft tissues. This is corroborated by the fact that piperacillin, a frequently administered beta-lactam antibiotic, often fails to be effective despite documented susceptibility of the causative pathogen in vitro.Prospective comparative study of two groups.The intensive care unit and research ward of an university hospital.Six patients with septic shock and a control group of six gender- and age-matched healthy volunteers.To measure piperacillin penetration into the interstitial space fluid of skeletal muscle and subcutaneous adipose tissue, we employed microdialysis after a single intravenous administration of 4.0 g of piperacillin to patients and healthy volunteers. Piperacillin concentrations were assayed by using reversed-phase high-pressure liquid chromatography.In septic shock patients, interstitial piperacillin concentrations in skeletal muscle and subcutaneous adipose tissue were five- to ten-fold lower than corresponding free plasma concentrations (p.03). Mean piperacillin concentrations in subcutaneous adipose tissue never exceeded 11 microg/mL, which is below the minimal inhibitory concentration for a range of relevant pathogens in patients with septic shock.The results of the present study demonstrate that in septic shock patients, piperacillin concentrations in the interstitial space may be subinhibitory, even though effective concentrations are attained in plasma. The lack of success of antimicrobial therapy in these patients thus might be attributable to inadequate target site penetration of antibiotics. |
| Databáze: | OpenAIRE |
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