title: Hepatic cyst penetration of cefazolin in patients receiving aspiration sclerotherapy.
abstract: Hepatic cyst infection is a potentially severe complication in cystic disease. Treatment demands effective antibiotic concentrations within the infected cyst.
  
  
  
  The aim of this study was to use elective hepatic cyst drainage as a unique pharmacokinetic model to investigate whether cefazolin, a first-generation cephalosporin, is able to penetrate hepatic cysts.
  
  
  
  Patients scheduled to undergo percutaneous aspiration sclerotherapy of a symptomatic non-infected, non-neoplastic hepatic cyst were eligible for this study. All participants received a single perioperative prophylactic dose of cefazolin (1000 mg, intravenously). We collected blood and cyst fluid samples to determine total and unbound cefazolin concentrations using HPLC. The primary outcome was hepatic cyst penetration, expressed as the ratio (%) of unbound concentration of cefazolin in cyst fluid to plasma (both in mg/L).
  
  
  
  We included eight patients [male = 25%, median age = 60 years (IQR 54-75), median estimated glomerular filtration rate = 97 mL/min/1.73 m(2) (IQR 67-102) and median serum albumin = 40 g/L (IQR 37-40)]. We detected low concentrations of unbound cefazolin in cyst fluid (≤1.0 mg/L). The median plasma unbound cefazolin peak level (immediately after cefazolin administration) was 36.6 mg/L (IQR 23.7-54.1) and the level at the time of cyst fluid aspiration was 16.1 mg/L (IQR 13.0-20.1). In total, the hepatic cyst penetration of free cefazolin was only 2.2% (IQR 0.7-5.2).
  
  
  
  We developed a study model to investigate the penetration of antibiotics into hepatic cysts. Cefazolin did not reach adequate intracystic concentrations. Future studies should explore alternatives.
authors.affiliation: Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Lantinga
authors.affiliation: Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: T F M
authors.initials: TF
authors.lastname: Wijnands
authors.affiliation: Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: R H M
authors.initials: RH
authors.lastname: Te Morsche
authors.affiliation: Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: R G L
authors.initials: RG
authors.lastname: de Sévaux
authors.affiliation: Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Kuipers
authors.affiliation: Department of Development and Regeneration, KU Leuven, Leuven, Belgium Intensive Care and Department of Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Allegaert
authors.affiliation: Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Burger
authors.affiliation: Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands joostphdrenth@cs.com.
authors.forename: J P H
authors.initials: JP
authors.lastname: Drenth
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001240:Aspirations, Psychological; D001424:Bacterial Infections / Q000188:drug therapy*; D012634:Bodily Secretions / Q000737:chemistry; D002437:Cefazolin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002851:Chromatography, High Pressure Liquid; D003560:Cysts / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry; D015911:Sclerotherapy
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin