Levels of vancomycin in the cerebral interstitial fluid after severe head injury

Intensive Care Med (2006) 134:325328

DOI 10.1007/s00134-005-0015-3 BRIEF REPORTAnselmo Caricato

Mariano Pennisi

Aldo Mancino

Gianluca Vigna

Claudio Sandroni

Andrea Arcangeli

Massimo AntonelliLevels of vancomycin in the cerebral

interstitial fluid after severe head injuryAbstract Objective: To evaluate

the concentrations of vancomycin

in the cerebral interstitial fluid

after intravenous administration by

multiple boli. Design: Prospective

non randomized study Setting:

University hospital general ICU

Patients: Four patients undergone

to craniotomy for evacuation of

cerebral posttraumatic hemorrhage,

who developed pneumonia 47 days

from the injury Methods: Two

microdialysis catheters were placed

in each patient: one in the edematous

brain surrounding the focal lesion

and one in the subcutaneous tissue

of abdomen. Levels of vancomycin

were measured in serum and in the

microdialysates samples. Results:

Plasmatic concentration of1015 g/ml in the trough level was

obtained after four administrations of

vancomycin. Levels of vancomycin

in the subcutaneous tissue was above

minimum inhibitory concentrations

in all patients after the second

administration. Mean serum/brain

ratio was 8%. Cerebral interstitial

concentration of vancomycin was

never above minimum inhibitory

concentrations; its maximum value

was 1.2 g/ml. Conclusions:In edematous brain close toa posttraumatic hemorrhage the levels

of vancomycin do not differ from

that in healthy subjects. At these

plasmatic concentrations cerebral

interstitial levels of vancomycin

were insufficient while subcutaneous

interstitial levels were effective for

clinical use.Keywords Blood-brain barrier Cerebral interstitial fluid

Cerebral posttraumatic hemorrhage

Microdialysis Severe head injury

VancomycinReceived: 26 February 2005Accepted: 03 November 2005

Published online: 24 January 2006

Springer-Verlag 2005A. Caricato () M. Pennisi A. Mancino G. Vigna C. Sandroni A. Arcangeli M. AntonelliCatholic University School of Medicine,

Department of Anesthesia and Intensive

Care,L.go A.Gemelli, 1 00168 Rome, Italy

e-mail: [email protected]

Tel.: [phone]Fax: [phone]IntroductionRenewed interest in vancomycin over the past decade

has led to substantial data concerning its pharmacokinetics, dose, and concentration response relationship.

However, several problems remain to be solved. Pharmacokinetics of antibiotics in intensive care unit is difficult

to study due to the occurrence of hypoalbuminemia,

edema, or organ failure. Furthermore the diffusion of

vancomycin through the blood-brain barrier c(BBB)

is known in healthy patients and when meningeal inflammation is present, but no data are available in

patients with traumatic head injury. In these cases the

permeability of BBB is variably increased, and the

penetration of drugs into cerebral spinal fluid (CSF)...