Netilmicin prophylaxis in open-heart surgery

Area of Science:

• Pharmacology
• Cardiovascular Surgery
• Infectious Diseases

Background:

• Prosthetic valve endocarditis (PVE) prophylaxis is crucial in cardiac surgery.
• Aminoglycosides, like netilmicin and gentamicin, are used in prophylaxis.
• Understanding antibiotic distribution in cardiac tissues is essential for optimizing treatment.

Purpose of the Study:

• To determine perioperative concentrations of netilmicin and gentamicin.
• To investigate antibiotic levels in serum, pericardial fluid, and atrial appendage.
• To assess antibiotic sequestration in pericardial fluid after multiple doses.

Main Methods:

• Eighty patients undergoing cardiac surgery were included.
• Patients received one or two pre-operative intramuscular doses of netilmicin or gentamicin.
• Concentrations of antibiotics were measured in serum, pericardial fluid, and atrial appendage tissue.

Main Results:

• Mean atrial appendage concentrations were 4.8 mg/kg (netilmicin) and 2.1 mg/kg (gentamicin) after a single dose.
• Mean serum concentrations were 6.9 mg/l (netilmicin) and 3.9 mg/l (gentamicin).
• Mean pericardial fluid concentrations were 3.8 mg/l (netilmicin) and 2.6 mg/l (gentamicin), with observed sequestration after two doses.

Conclusions:

• Netilmicin and gentamicin achieve measurable concentrations in cardiac tissues and fluids.
• Antibiotic sequestration in pericardial fluid may occur after multiple pre-operative doses.
• Trends in PVE etiology suggest evolving prophylaxis strategies may be needed.