title: Pharmacokinetics and tissue penetration of vancomycin continuous infusion as prophylaxis for vascular surgery.
abstract: OBJECTIVE
  To determine the tissue penetration of vancomycin into perivascular fat and arterial wall during a continuous infusion of vancomycin, given as prophylaxis for vascular surgery.
  
  
  METHODS
  Patients undergoing arterial reconstruction requiring antibiotic prophylaxis were included. Patients received a loading infusion of vancomycin the evening prior to surgery followed by a continuous 24 h infusion, calculated according to renal function. Three peri-operative serum samples and intra-operative perivascular fat and arterial wall samples were collected for vancomycin assay.
  
  
  RESULTS
  Twenty-eight patients were included. Three serum samples were obtained from all patients, fat samples were available from 27 (96.4%) patients and vessel wall samples were available from 23 (82.1%) patients. Serum vancomycin concentrations were maintained within a relatively narrow range, while fat and arterial wall concentrations were highly variable.
  
  
  CONCLUSIONS
  This study has shown that prophylactic administration of vancomycin with a loading infusion followed by a continuous infusion before and during vascular surgery achieves serum and vascular tissue concentrations that are above the MICs for most common organisms implicated in post-operative graft infection. However, penetration into perivascular fat tissues is poor.
authors.affiliation: Department of Vascular and General Surgery, Gartnavel General Hospital, 1055 Great Western Road, Glasgow G12 0XH, Scotland, UK. chrispayne@doctors.org.uk
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Payne
authors.forename: Alison H
authors.initials: AH
authors.lastname: Thomson
authors.forename: Adam T
authors.initials: AT
authors.lastname: Stearns
authors.forename: David G
authors.initials: DG
authors.lastname: Watson
authors.forename: Tong
authors.initials: T
authors.lastname: Zhang
authors.forename: David B
authors.initials: DB
authors.lastname: Kingsmore
authors.forename: Dominique S
authors.initials: DS
authors.lastname: Byrne
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Binning
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001158:Arteries / Q000378:metabolism* / Q000601:surgery; D006801:Humans; D007262:Infusions, Intravenous; D011183:Postoperative Complications / Q000517:prevention & control; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000517:prevention & control*; D050151:Subcutaneous Fat / Q000378:metabolism*; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use; D014656:Vascular Surgical Procedures
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin