title: [Evaluation of the tissue diffusion capacity of antibiotics in lower limb ischaemia].
abstract: BACKGROUND
  The aim of the study was to assess whether the penetration of antibiotics is affected by decreased tissue perfusion in patients with limb ischaemia, thus reducing its concentration in tissues below the minimum inhibitory concentration (MIC) breakpoints of antibiotics for different microorganisms.
  
  
  METHODS
  Prospective study. Candidates for major amputation with critical lower limb ischaemia and an infection on antibiotic treatment, were included. Three levels of perfusion in the lower limb were determined by measuring the transcutaneous oxygen pressure (TcPO2). A central line blood specimen, as well as biopsies of the skin, muscle, and bone, were taken at each perfusion level. The antibiotic concentration was determined using HPLC.
  
  
  RESULTS
  The total number of cases was 61 (46 patients): 6 clindamycin, 9 vancomycin, 8 linezolid, 18 levofloxacin, 9 ceftazidime, and 11 meropenem. Statistically significant differences were found in TcPO2 at all levels (ANOVA, P=.000). The vancomycin, levofloxacin and ceftazidime skin concentration depends on perfusion. Vancomycin and levofloxacin diffusion in bone is worse than in other tissues. Ceftazidime concentration does not exceed the MIC breakpoint of Pseudomonas aeruginosa in ischaemic tissues.
  
  
  CONCLUSIONS
  Meropenem and linezolid diffuse in all tissues, regardless of perfusion, reaching concentrations above the MIC of the target microorganisms, ensuring its effectiveness in ischaemic tissues.
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Complejo Hospitalario Universitario de Granada, Granada, España. Electronic address: silvialozanoalonso@gmail.com.
authors.forename: Silvia
authors.initials: S
authors.lastname: Lozano-Alonso
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Complejo Hospitalario Universitario de Granada, Granada, España.
authors.forename: José Patricio
authors.initials: JP
authors.lastname: Linares-Palomino
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Universitario Virgen de la Victoria, Málaga, España.
authors.forename: Blanca
authors.initials: B
authors.lastname: Vera-Arroyo
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Complejo Hospitalario de Jaén, Jaén, España.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Bravo-Molina
authors.affiliation: Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Granada, Granada, España.
authors.forename: José
authors.initials: J
authors.lastname: Hernández-Quero
authors.affiliation: Departamento de Cirugía, Universidad de Granada, Granada, España.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ros-Díe
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics*; D002442:Ceftazidime; D002851:Chromatography, High Pressure Liquid; D002981:Clindamycin / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D007511:Ischemia / Q000378:metabolism*; D064704:Levofloxacin / Q000493:pharmacokinetics; D000069349:Linezolid / Q000493:pharmacokinetics; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D012867:Skin / Q000378:metabolism; D013845:Thienamycins / Q000493:pharmacokinetics; D014640:Vancomycin / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D002981:Clindamycin; D064704:Levofloxacin; D014640:Vancomycin; D002442:Ceftazidime; D000077731:Meropenem; D000069349:Linezolid
keywords: Amputación; Amputation; Antibiotics; Antibióticos; Diffusion; Difusión; Ischaemia; Isquemia