Vancomycin continuous infusion as prophylaxis for vascular surgery.

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Pharmacokinetics

Background:

• Prosthetic graft infection is a serious complication in 3%-5% of vascular surgeries.
• Staphylococci are common pathogens, leading to vancomycin use in surgical prophylaxis.
• The efficacy of standard vancomycin regimens in achieving therapeutic concentrations is uncertain.

Purpose of the Study:

• To evaluate if a continuous vancomycin infusion regimen maintains adequate serum concentrations during perioperative prophylaxis for vascular procedures.
• To assess the achievement of target vancomycin serum concentrations (10-25 mg/L) in patients undergoing vascular surgery with prosthetic grafts.

Main Methods:

• Thirty-four patients received vancomycin prophylaxis with a loading dose and a 24-hour continuous infusion based on creatinine clearance.
• Serum vancomycin concentrations were measured at anesthesia induction, 2 hours postoperatively, and at infusion completion.
• Perioperative fluid, blood loss, and postoperative creatinine clearance were recorded.

Main Results:

• Eighty-one percent of all collected samples achieved the target vancomycin concentration range (10-25 mg/L).
• All analyzed patients reached target concentrations at at least one time point.
• No toxic vancomycin concentrations or adverse reactions were observed.

Conclusions:

• Continuous vancomycin infusion is an effective method for achieving adequate perioperative serum concentrations in vascular surgery.
• This regimen provides appropriate antibiotic levels during the intervention period.
• Further studies are needed to correlate these findings with long-term prosthetic graft infection rates.