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Published on: October 25, 2013

Impaired target site penetration of vancomycin in diabetic patients following cardiac surgery

Keso Skhirtladze1, Doris Hutschala, Tatjana Fleck

  • 1Department of Cardiothoracic and Vascular Anesthesia & CCM, University of Vienna, General Hospital, Waeringer Guertel 18-20, A-1090 Vienna, Austria.

Antimicrobial Agents and Chemotherapy
|March 30, 2006
PubMed

Insights

Diabetic patients show significantly lower vancomycin tissue concentrations after cardiac surgery compared to non-diabetics. This impaired drug penetration may explain treatment failures and rising antimicrobial resistance in diabetic populations.

Area of Science:

  • Pharmacology
  • Diabetic Complications
  • Infectious Diseases

Background:

  • Soft tissue infections are a serious complication in diabetic patients post-surgery.
  • Vancomycin is frequently used, but high mortality persists, potentially due to poor drug penetration.
  • Impaired tissue penetration of antibiotics may be a key factor in treatment outcomes for diabetic patients.

Purpose of the Study:

  • To quantify and compare vancomycin tissue concentrations in diabetic versus non-diabetic patients after cardiac surgery.
  • To investigate the relationship between vancomycin plasma and tissue levels in these patient groups.
  • To explore the implications of vancomycin tissue penetration for treatment efficacy and antimicrobial resistance.

Main Methods:

  • Prospective study measuring vancomycin concentrations in soft tissues and plasma.
  • Continuous intravenous vancomycin infusion (80-120 mg/h) in six diabetic and six non-diabetic patients post-cardiac surgery.
  • Microdialysis used to determine steady-state vancomycin levels on day 8+/-4.

Main Results:

  • Vancomycin tissue concentrations were significantly lower in diabetic patients (3.7 mg/L) compared to non-diabetics (11.9 mg/L) (P=0.002).
  • The median vancomycin tissue/plasma concentration ratio was substantially lower in diabetics (0.1) versus non-diabetics (0.3) (P=0.002).
  • These findings indicate significantly impaired vancomycin penetration into soft tissues in diabetic patients.

Conclusions:

  • Vancomycin tissue penetration is substantially impaired in diabetic patients compared to non-diabetic individuals.
  • Insufficient vancomycin concentrations at target tissues may contribute to treatment failure in diabetic patients.
  • Impaired penetration could play a role in the development of antimicrobial resistance among diabetic patients.

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