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Association Between Vancomycin Blood Brain Barrier Penetration and Clinical Response in Postsurgical Meningitis
Qing Wang1, Si Chen, Yan-Gang Zhou
1The Second Xiangya Hospital of Central South University, Department of Pharmacy/Institute of Clinical Pharmacy, Changsha, Hunan, P.R. China.
Purpose:
This study investigated the association between vancomycin blood brain barrier penetration and clinical response in patients with postsurgical meningitis.
Methods:
Adult patients with postsurgical meningitis were recruited. Eligible patients received vancomycin 500 mg every 6 h for at least 5 days. On day 3 or 4, cerebrospinal fluid (CSF) and simultaneous serum samples were obtained to determine CSF minimum concentrations (Cmin), serum Cmin and CSF to serum Cmin ratio.
Results:
Twenty-two patients (14 men and 8 women; mean age of 52.6± 12.1 years) were recruited. The vancomycin Cmin was 3.63 ± 1.64 mg/L in CSF and 13.38 ± 5.36 mg/L in serum, with the CSF to serum Cmin ratio of 0.291 ± 0.118. The Cmin in serum and in CSF showed a significant correlation (p=0.005, r =0.575). The vancomycin CSF Cmin had a significant correlation with the decline of white blood cell counts (WBCs) in CSF (p=0.003, r =0.609). CSF Cmin, serum Cmin and CSF to serum Cmin ratio all showed no significant correlation with clinical response (p=0.335, 0.100, 0.679, respectively).
Conclusions:
There was a positive correlation between serum Cmin and CSF Cmin. However, only CSF Cmin is positively correlated with WBCs improvement in CSF. All other parameters such as serum Cmin, CSF Cmin and CSF to serum Cmin ratio had no correlation with clinical response. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.
Insights
Vancomycin penetration into cerebrospinal fluid (CSF) correlates with serum levels and white blood cell count reduction in meningitis patients. However, neither CSF nor serum vancomycin concentrations predicted overall clinical response.
Area of Science:
- Infectious Diseases
- Pharmacokinetics
- Neuroscience
Background:
- Bacterial meningitis, particularly postsurgical meningitis, presents a significant clinical challenge.
- Optimizing antibiotic penetration across the blood-brain barrier (BBB) is crucial for effective treatment.
- Vancomycin is a key antibiotic used in treating meningitis, but its efficacy depends on achieving adequate concentrations in the cerebrospinal fluid (CSF).
Purpose of the Study:
- To investigate the relationship between vancomycin concentrations in serum and CSF.
- To determine the association between vancomycin CSF penetration and clinical outcomes in patients with postsurgical meningitis.
- To evaluate the correlation between vancomycin CSF levels and inflammatory markers like white blood cell (WBC) counts.
Main Methods:
- Adult patients diagnosed with postsurgical meningitis were enrolled.
- Patients received a standardized dose of vancomycin (500 mg every 6 hours) for a minimum of 5 days.
- CSF and serum samples were collected on days 3 or 4 to measure vancomycin minimum concentrations (Cmin) and the CSF to serum Cmin ratio.
Main Results:
- A significant positive correlation was observed between serum vancomycin Cmin and CSF vancomycin Cmin (p=0.005, r=0.575).
- CSF vancomycin Cmin showed a significant correlation with the reduction of WBCs in CSF (p=0.003, r=0.609).
- No significant correlation was found between serum Cmin, CSF Cmin, or the CSF to serum Cmin ratio and the overall clinical response of the patients.
Conclusions:
- Vancomycin serum concentrations are predictive of CSF concentrations in postsurgical meningitis.
- CSF vancomycin Cmin is associated with improvement in CSF inflammatory markers (WBCs).
- Therapeutic drug monitoring of vancomycin, based solely on serum levels or CSF penetration, may not directly predict clinical cure in this patient population.
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