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· DOS Abstracts
Bone, Subcutaneous Tissue and Plasma
Pharmacokinetics of Vancomycin in Total Knee
Replacement Patients
Mats Bue, Mikkel Tøttrup, Pelle Hanberg, Otto Langhoff, Hanne Birke-Sørensen,
Kjeld Søballe
Department of Orthopaedic Surgery, Horsens Regional Hospital; Department
of Orthopaedic Surgery, Randers Regional Hospital; Orthopaedic Research
Unit, Aarhus University Hospital; Department of Orthopaedic Surgery, Horsens
Regional Hospital; Orthopaedic Research Unit, Aarhus University Hospital;
Department of Orthopaedic Surgery, Aarhus University Hospital
Background:
High treatment failure rates and the need for prolonged anti-
microbial therapy for osteomyelitis and implant-associated infections suggest
that antimicrobial bone penetration may be incomplete. Assessment of the bone
pharmacokinetics of antimicrobials is challenged by a lack of validated methods.
Purpose / Aim of Study:
The objective of this study was to compare and de-
scribe plasma, subcutaneous tissue and bone pharmacokinetics of vancomycin
in patients.
Materials and Methods:
Postoperatively, 1,000 mg of vancomycin was ad-
ministered to ten male patients undergoing total knee replacement as a single
dose over 100 min. Plasma, subcutaneous tissue and bone pharmacokinetics
were investigated over 8 hours. Microdialysis catheters were applied for collec-
tion of samples in bone and subcutaneous tissue. Venous samples were drawn
from a venous catheter. The vancomycin concentration in microdialysates was
determined using ultra-high performance liquid chromatography, whilst the free
plasma concentration was determined using Cobas c501.
Findings / Results:
For all extravascular tissue, an impaired penetration was
demonstrated. Area under the concentration- time curve (AUC) were found
lower for bone and subcutaneous tissue when compared to free plasma. The
lowest AUC was found in cortical bone.
Conclusions:
Bone penetration of vancomycin was found to be incomplete and
delayed. Future studies should further focus on validating the applicability of
microdialysis for assessment of antimicrobial bone pharmacokinetics.
No conflicts of interest reported
49.