title: Drug concentrations in the serum and cerebrospinal fluid of patients treated with cefoperazone/sulbactam after craniotomy.
abstract: BACKGROUND
  To identify changes in cefoperazone/sulbactam penetration into cerebrospinal fluid (CSF) after craniotomy and to investigate preliminarily whether cefoperazone/sulbactam CSF concentration can reach therapeutic level when administered intravenously after neurosurgical operation.
  
  
  METHODS
  Neurosurgical patients with an indwelling ventricular drainage pipe who received prophylactic cefoperazone/sulbactam for the treatment of intracranial infection were received a cefoperazone/sulbactam 2:1, 3.0-g infusion for 3 hours every 6 hours for 24 h. Venous blood and CSF specimens were collected to determine cefoperazone/sulbactam concentrations.
  
  
  RESULTS
  The cefoperazone and sulbactam concentrations in serum were highest at the second hour (237.54 ± 336.72 mg/L and 66.52 ± 80.38 mg/L, respectively) and then decreased. The cefoperazone and sulbactam concentrations in CSF were highest at the 4th hour (39.22 ± 75.55 mg/L and 6.24 ± 8.35 mg/L, respectively) and then decreased. CSF penetration measured by the ratio of peak concentrations (CSF/serum) was 8.6% ± 7.2% for cefoperazone and 13.5% ± 11.9% for sulbactam, CSF penetration measured by the ratio of trough concentrations (CSF/serum) was 13.4% ± 5.3% for cefoperazone and 106.5% ± 87.5% for sulbactam. CSF penetration represented by the ratio of area under the curve (AUC) of CSF and serum was 14.5% for cefoperazone and 22.6% for sulbactam. Neurosurgical impairment of the blood-brain barrier may improve the CSF penetration of these drugs, but it is difficult to reach the MIC90 of resistant bacteria. If single intravenous administration time was extended to 3 hours, the serum concentrations of drugs were able to meet the PK/PD standard (T> MIC%> 50%) for treating common, highly resistant bacteria.
  
  
  CONCLUSIONS
  The CSF penetration of cefoperazone/sulbactam may be enhanced after neurosurgical impairment of the blood-brain barrier. This study is a pilot research of cefoperazone/sulbactam using in neurosurgical individuals, However, it needs to be confirmed by further large-scale studies.
authors: Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 PR China.
authors: Qiang
authors: Q
authors: Wang
authors: Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 PR China.
authors: Yuanxing
authors: Y
authors: Wu
authors: Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 PR China.
authors: Biyao
authors: B
authors: Chen
authors: Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 PR China.
authors: Jianxin
authors: J
authors: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage / Q000097:blood / Q000134:cerebrospinal fluid; D002438:Cefoperazone / Q000008:administration & dosage / Q000097:blood* / Q000134:cerebrospinal fluid*; D003399:Craniotomy; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015610:Serum Bactericidal Test; D013407:Sulbactam / Q000008:administration & dosage / Q000097:blood* / Q000134:cerebrospinal fluid*; D013997:Time Factors
chemical_list: D000892:Anti-Infective Agents, Urinary; D004338:Drug Combinations; D002438:Cefoperazone; D013407:Sulbactam
keywords: Cefoperazone; Cerebrospinal fluid; Concentration; Serum; Sulbactam