Clinical infectious diseases, ISSN 1058-4838 vol. 42, suppl. 1, January 2006
61 s. : il., tab. ; 28 cm
- MeSH
- Vancomycin Resistance immunology MeSH
- Vancomycin pharmacology pharmacokinetics therapeutic use MeSH
- Publication type
- Collected Work MeSH
- Conspectus
- Farmacie. Farmakologie
- NML Fields
- infekční lékařství
- farmacie a farmakologie
The study presents a novel vancomycin-releasing collagen wound dressing derived from Cyprinus carpio collagen type I cross-linked with carbodiimide which retarded the degradation rate and increased the stability of the sponge. Following lyophilization, the dressings were subjected to gamma sterilization. The structure was evaluated via scanning electron microscopy images, micro-computed tomography, and infrared spectrometry. The structural stability and vancomycin release properties were evaluated in phosphate buffered saline. Microbiological testing and a rat model of a wound infected with methicillin-resistant Staphylococcus aureus (MRSA) were then employed to test the efficacy of the treatment of the infected wound. Following an initial mass loss due to the release of vancomycin, the sponges remained stable. After 7 days of exposure in phosphate buffered saline (37°C), 60% of the material remained with a preserved collagen secondary structure together with a high degree of open porosity (over 80%). The analysis of the release of vancomycin revealed homogeneous distribution of the antibiotic both across and between the sponges. The release of vancomycin was retarded as proved by in vitro testing and further confirmed by the animal model from which measurable concentrations were observed in blood samples 24 hours after the subcutaneous implantation of the sponge, which was more than observed following intraperitoneal administration. The sponge was also highly effective in terms of reducing the number of colony-forming units in biopsies extracted from the infected wounds 4 days following the inoculation of the wounds with the MRSA solution. The presented sponges have ideal properties to serve as wound dressing for prevention of surgical site infection or treatment of already infected wounds.
- MeSH
- Anti-Bacterial Agents pharmacokinetics MeSH
- Wound Healing drug effects MeSH
- Carps MeSH
- Carbodiimides pharmacokinetics MeSH
- Collagen pharmacokinetics MeSH
- Rats MeSH
- Methicillin-Resistant Staphylococcus aureus drug effects MeSH
- Bandages MeSH
- Vancomycin pharmacokinetics MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: The topical application of Vancomycin is increasingly being used in orthopedics because of the development of methicillin resistant bacteria. Consequently, resistance to Vancomycin has recently been on the rise. One possible explanation for this phenomenon could be the thermal degradation of Vancomycin to antibacterially inactive crystalline degradation products (CDP-1s). The aim of our in vitro experiment was to compare the creation and elution characteristics of CDP-1s and the active form of Vancomycin (factor B) released from bone grafts. METHODS: CDP-1s and the factor B released from bone grafts into the buffer solution were measured using the high-performance liquid chromatography method at progressive intervals. RESULTS: The factor B was released from bone grafts at the highest levels, typically on the first day (618.8 mg/L). CDP-1 levels kept increasing until the end of measurement on day 15, when the concentration of CDP-1s (1280.7 mg/L) was much higher compared to that of factor B (217.5 mg/L). CONCLUSIONS: We confirmed the tendency of Vancomycin to convert to antimicrobially ineffective CDP-1s. Although Vancomycin is decomposed into crystalline degradation products, its active forms are released from bone grafts in sufficient concentration for more than two keks (Tab. 3, Fig. 1, Ref. 15).
- MeSH
- Anti-Bacterial Agents administration & dosage pharmacology chemistry MeSH
- Crystallization MeSH
- Humans MeSH
- Drug Carriers * MeSH
- Osteomyelitis * MeSH
- In Vitro Techniques MeSH
- Bone Transplantation MeSH
- Vancomycin administration & dosage pharmacology chemistry MeSH
- Chromatography, High Pressure Liquid MeSH
- Check Tag
- Humans MeSH
Vancomycin is frequently used in haemodialysis (HD) patients but generally accepted target serum ranges and dosing strategy are still lacking in this group. Based on retrospective analysis of data from 118 HD patients treated with vancomycin the interdialytic elimination constant (Ke), apparent volume of distribution (Vd) and dialysis efficacy were calculated. The influence of possible clinical variables on the pharmacokinetic parameters of vancomycin have been tested. The median of Ke in interdialytic periods, corresponding half-life and Vd were 0.0073 h-1, 95.0 h and 0.87 L/kg, respectively. We found significant positive correlation between time in dialysis program and Ke. The Vd correlated best with lean body mass (LBM). For high- and low flux membrane HD of 4 hours duration the decline in vancomycin levels was 20.88% and 12.86%, respectively. Based on these data loading dose for vancomycin in HD patient should be calculated as 24.483 × LBM (kg) + 455 mg. The utility of this equation for entire HD population should be also verified prospectively.
- MeSH
- Anti-Bacterial Agents MeSH
- Renal Dialysis MeSH
- Humans MeSH
- Drug Monitoring * MeSH
- Half-Life MeSH
- Retrospective Studies MeSH
- Vancomycin * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Keywords
- avoparcin,
- MeSH
- Drug Resistance, Bacterial genetics drug effects MeSH
- Enterococcus physiology genetics classification ultrastructure MeSH
- Vancomycin-Resistant Enterococci * genetics drug effects ultrastructure MeSH
- Gene Expression genetics drug effects MeSH
- Glycopeptides drug effects MeSH
- Cross Infection mortality transmission MeSH
- Humans MeSH
- Vancomycin MeSH
- Zoonoses transmission MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Drug Resistance, Bacterial genetics immunology MeSH
- Enterococcus faecalis genetics drug effects MeSH
- Enterococcus faecium genetics drug effects MeSH
- Vancomycin-Resistant Enterococci * genetics pathogenicity drug effects MeSH
- Phenotype MeSH
- Genotype MeSH
- Glycopeptides pharmacology metabolism therapeutic use MeSH
- Cross Infection microbiology prevention & control MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
AIMS: To determine the extent of vancomycin removal and vancomycin pharmacokinetics in septic patients with AKI using daily hemodialysis with polysulphone high-flux and low-flux membrane. METHODS: Five patients received 6 h daily dialysis with low-flux polysulphone membrane, four patients with high-flux polysulphone membrane. Vancomycin was administered over the last hour of dialysis. The maintenance dose was adjusted based on pre-hemodialysis serum concentrations. Patients were followed up for two days. RESULTS: Median percentage of vancomycin removal by low-flux membrane dialysis was 17% (8-38%) and by high-flux membrane dialysis was 31% (13-43%). Vancomycin clearance was only moderately higher in high-flux membrane dialysis (median 3.01 L/h, range 2.34-3.5 L/h) compared to low-flux dialysis (median 2.48 L/h, range 0.53-5.68 L/h) in the first day of the study. About two-fold higher vancomycin clearance in high-flux dialysis (median 3.62 L/h, range 1.37-5.07 L/h) was observed on the second day of the study than low-flux dialysis (median 1.74 L/h, range 0.75-30.94 L/h). CONCLUSIONS: Both high-flux and low-flux membrane dialysis remove considerable amounts of vancomycin in critically ill septic patients with AKI. Application of vancomycin after each dialysis was required to maintain therapeutic concentrations.
- MeSH
- Anti-Bacterial Agents pharmacokinetics MeSH
- Renal Dialysis * MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Sepsis drug therapy metabolism MeSH
- Vancomycin pharmacokinetics MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
