The effect of intraoperative autotransfusion on antibiotic pharmacokinetics during elective abdominal aortic aneurysm repair.
OBJECTIVE
Blood loss during aortic surgery has been reduced by the use of cell-salvage techniques (CS). Antibiotics are used routinely to prevent prosthetic graft infection. The influence of CS on antibiotic levels is unknown. This study measured antibiotic levels in serum and cell-salvage fluid during aortic reconstruction.


METHODS
Teicoplanin, a glycopeptide with activity against gram positive bacteria was the antibiotic studied. Serial blood levels were measured after a single intravenous dose (400 mg) in five patients undergoing elective aortic aneurysm repair. Patient ages ranged from 67 to 82 yr. Cell-salvage (Dideco compact A75171) fluid was also assayed.


METHODS
District General Hospital


RESULTS
Serum teicoplanin levels peaked at mean 67.8 mg/l (SD 8.9 mg/l) 5 min after administration, and fell to mean 2.88 mg/l (SD 0.4 mg/l) at 720 min. This is less than levels in healthy volunteers but above the MIC90 for most Gram positive bacterial pathogens encountered in aortic surgery. Teicoplanin levels in discarded CS fluid at the end of the procedure were 0.56 mg/l (SD 0.71 mg/l).


CONCLUSIONS
Teicoplanin blood levels are reduced during aortic surgery. Levels remain adequate for antibacterial prophylaxis for 12 h postoperatively other than for methicillin-resistant staphylococcus epidermidis (MRSE). Compared with patients undergoing arterial reconstruction without the use of a cell-salvage device there is no significant loss due to CS use.
Aiono
S
S
Department of Surgery, Royal Berkshire Hospital, Reading, UK.
Stacey
A
A
Magee
T R
TR
Galland
R B
RB
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D017544:Aortic Aneurysm, Abdominal / Q000378:metabolism* / Q000601:surgery*; D001804:Blood Transfusion, Autologous; D019917:Blood Vessel Prosthesis Implantation; D017558:Elective Surgical Procedures; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000517:prevention & control; D006801:Humans; D007275:Injections, Intravenous; D007432:Intraoperative Period; D008297:Male; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000097:blood / Q000517:prevention & control; D017334:Teicoplanin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D017334:Teicoplanin