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Vancomycin concentrations in infected and noninfected human bone.
A L Graziani1, L A Lawson, G A Gibson
1Pharmacy and Drug Information Services, Hospital of the University of Pennsylvania, Philadelphia.
Antimicrobial Agents and Chemotherapy
|September 1, 1988
Summary
Vancomycin bone concentrations were assessed in patients receiving prophylactic or therapeutic doses. In most patients, bone vancomycin levels exceeded the minimum inhibitory concentration for staphylococci, suggesting efficacy.
Area of Science:
- Pharmacology
- Orthopedic Surgery
- Infectious Diseases
Background:
- Vancomycin is a critical antibiotic for treating Gram-positive bacterial infections.
- Understanding vancomycin penetration into bone is crucial for optimizing treatment of osteomyelitis and preventing surgical site infections.
Purpose of the Study:
- To quantify vancomycin concentrations in cancellous and cortical bone.
- To evaluate vancomycin bone levels in patients receiving prophylactic and therapeutic doses.
Main Methods:
- Bone specimens were collected from patients undergoing total hip arthroplasty (prophylactic vancomycin) and those with osteomyelitis (therapeutic vancomycin).
- Vancomycin concentrations in bone were measured using fluorescence polarization immunoassay after pulverizing and eluting bone specimens.
Main Results:
- In prophylactic group patients, vancomycin was detected in most cancellous and cortical bone specimens.
- In osteomyelitis patients, vancomycin was detected in a limited number of cortical bone specimens, with variable concentrations.
- Detected bone vancomycin levels in prophylactic group patients generally exceeded the minimum inhibitory concentration (MIC) for susceptible staphylococci.
Conclusions:
- Single prophylactic doses of vancomycin achieved bone concentrations above the MIC for susceptible staphylococci in most patients.
- Bone penetration of vancomycin in infected patients (osteomyelitis) was variable and warrants further investigation.