Levels of vancomycin in the cerebral interstitial fluid after severe head injury.
OBJECTIVE
To evaluate the concentrations of vancomycin in the cerebral interstitial fluid after intravenous administration by multiple boli.


METHODS
Prospective non randomized study


METHODS
University hospital general ICU.


METHODS
Four patients undergone to craniotomy for evacuation of cerebral posttraumatic hemorrhage, who developed pneumonia 4-7 days from the injury


METHODS
Two microdialysis catheters were placed in each patient: one in the edematous brain surrounding the focal lesion and one in the subcutaneous tissue of abdomen. Levels of vancomycin were measured in serum and in the microdialysates samples.


RESULTS
Plasmatic concentration of 10-15 microg/ml in the trough level was obtained after four administrations of vancomycin. Levels of vancomycin in the subcutaneous tissue was above minimum inhibitory concentrations in all patients after the second administration. Mean serum/brain ratio was 8%. Cerebral interstitial concentration of vancomycin was never above minimum inhibitory concentrations; its maximum value was 1.2 microg/ml.


CONCLUSIONS
In edematous brain close to a posttraumatic hemorrhage the levels of vancomycin do not differ from that in healthy subjects. At these plasmatic concentrations cerebral interstitial levels of vancomycin were insufficient while subcutaneous interstitial levels were effective for clinical use.
Caricato
Anselmo
A
Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy. anselmo.caricato@fastwebnet.it.
Pennisi
Mariano
M
Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
Mancino
Aldo
A
Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
Vigna
Gianluca
G
Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
Sandroni
Claudio
C
Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
Arcangeli
Andrea
A
Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
Antonelli
Massimo
M
Department of Anesthesia and Intensive Care, Catholic University School of Medicine, L.go A.Gemelli, 1 00168, Rome, Italy.
D000328:Adult; D000900:Anti-Bacterial Agents / Q000378:metabolism*; D001812:Blood-Brain Barrier; D006259:Craniocerebral Trauma / Q000378:metabolism*; D003399:Craniotomy; D045604:Extracellular Fluid; D006801:Humans; D008297:Male; D017551:Microdialysis; D011446:Prospective Studies; D014640:Vancomycin / Q000378:metabolism*
D000900:Anti-Bacterial Agents; D014640:Vancomycin