Postoperatively administered vancomycin reaches therapeutic concentration in the cerebral spinal fluid of neurosurgical patients

• Published in: Surgical neurology Vol. 69; no. 2; pp. 126 - 129
• Main Authors: Wang, Qiang, MD, Shi, Zhonghua, MD, Wang, Jiangfei, MD, Shi, Guangzhi, MD, Wang, Shuo, MD, Zhou, Jianxin, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2008
• Subjects: Adult; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - cerebrospinal fluid; Anti-Bacterial Agents - pharmacokinetics; Blood-brain barrier; Blood-Brain Barrier - metabolism; Brain Diseases - cerebrospinal fluid; Brain Diseases - pathology; Brain Diseases - surgery; Cerebral spinal fluid; Craniotomy; Drainage; Drug Administration Schedule; Drug concentration; Female; Humans; Male; Middle Aged; Neurology; Neurosurgical operation; Postoperative Care; Spinal Puncture; Surgery; Vancomycin; Vancomycin - administration & dosage; Vancomycin - cerebrospinal fluid; Vancomycin - pharmacokinetics; LPD; BBB; Neurosurgical operation; methicillin-resistant Staphylococcus aureus; Vancomycin; NNIS; coagulase-negative staphylococci; high-pressure liquid chromatography; SD; CSF; MRSA; methicillin-resistant coagulase-negative staphylococci; intensive care unit; Drug concentration; lumbar puncture drainage; HPLC; AUFS; blood-brain barrier; ventricular drainage; cerebral spinal fluid; 90% minimum inhibitory concentration; surgical site infection; SSI; National Nosocomial Infections Surveillance; VD; CoNS; absorbance unit full scale; MIC 90; ICU; MRCoNS; standard deviation; Cerebral spinal fluid; Blood-brain barrier
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2007.01.073

Abstract Background The purpose of this study was to investigate whether vancomycin CSF concentration can reach therapeutic level when administered intravenously after neurosurgical operation. Methods After patients were admitted to the ICU, vancomycin (1.0 g) was injected intravenously, and CSF was collected from either ventricular drainage (VD group, n = 9) or LPD (LPD group, n = 10). The CSF concentration of vancomycin was measured using HPLC. Results Peak concentration occurred at 15 to 30 minutes after venoclysis (6.24 ± 3.46 mg/L in the VD group and 4.49 ± 3.14 mg/L in the LPD group, respectively) and reached or even exceeded the MIC90 for MRSA (2 mg/L) and MRCoNS (2 mg/L). Twelve hours later, CSF vancomycin concentration in the VD and LPD groups was 2.55 ± 1.13 and 2.43 ± 0.41 mg/L, respectively. Conclusions Neurosurgical operation may disrupt the integrality of BBB so that vancomycin can penetrate through the BBB easily and reach therapeutic concentration of CSF when administered intravenously after operation. This finding suggests that vancomycin can be administered intravenously when used to treat intracranial infection after neurosugical operation.