1
|
De Sutter PJ, Hermans E, De Cock P, Van Bocxlaer J, Gasthuys E, Vermeulen A. Penetration of Antibiotics into Subcutaneous and Intramuscular Interstitial Fluid: A Meta-Analysis of Microdialysis Studies in Adults. Clin Pharmacokinet 2024; 63:965-980. [PMID: 38955946 DOI: 10.1007/s40262-024-01394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND AND OBJECTIVE The interstitial fluid of tissues is the effect site for antibiotics targeting extracellular pathogens. Microdialysis studies investigating these concentrations in muscle and subcutaneous tissue have reported notable variability in tissue penetration. This study aimed to comprehensively summarise the existing data on interstitial fluid penetration in these tissues and to identify potential factors influencing antibiotic distribution. METHODS A literature review was conducted, focusing on subcutaneous and intramuscular microdialysis studies of antibiotics in both adult healthy volunteers and patients. Random-effect meta-analyses were used to aggregate effect size estimates of tissue penetration. The primary parameter of interest was the unbound penetration ratio, which represents the ratio of the area under the concentration-time curve in interstitial fluid relative to the area under the concentration-time curve in plasma, using unbound concentrations. RESULTS In total, 52 reports were incorporated into this analysis. The unbound antibiotic exposure in the interstitial fluid of healthy volunteers was, on average, 22% lower than in plasma. The unbound penetration ratio values were higher after multiple dosing but did not significantly differ between muscle and subcutaneous tissue. Unbound penetration ratio values were lower for acids and bases compared with neutral antibiotics. Neither the molecular weight nor the logP of the antibiotics accounted for the variations in the unbound penetration ratio. Obesity was associated with lower interstitial fluid penetration. Conditions such as sepsis, tissue inflammation and tissue ischaemia were not significantly associated with altered interstitial fluid penetration. CONCLUSIONS This study highlights the variability and generally lower exposure of unbound antibiotics in the subcutaneous and intramuscular interstitial fluid compared with exposure in plasma. Future research should focus on understanding the therapeutic relevance of these differences and identify key covariates that may influence them.
Collapse
Affiliation(s)
- Pieter-Jan De Sutter
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.
| | - Eline Hermans
- Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
- Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Pieter De Cock
- Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
| | - Jan Van Bocxlaer
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Elke Gasthuys
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - An Vermeulen
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| |
Collapse
|
2
|
Kaspersen AE, Hanberg P, Hvistendahl MA, Bue M, Schmedes AV, Høy K, Stilling M. Evaluation of cefuroxime concentration in the intrathecal and extrathecal compartments of the lumbar spine-an experimental study in pigs. Br J Pharmacol 2023; 180:1832-1842. [PMID: 36710378 DOI: 10.1111/bph.16045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Optimal antibiotic prophylaxis is crucial to prevent postoperative infection in spinal surgery. Sufficient time above the minimal inhibitory concentration (fT > MIC) for relevant bacteria in target tissues is required for cefuroxime. We assessed cefuroxime concentrations and fT > MIC of 4 μg·ml-1 for Staphylococcus aureus in the intrathecal (spinal cord and cerebrospinal fluid, CSF) and extrathecal (epidural space) compartments of the lumbar spine. EXPERIMENTAL APPROACH Eight female pigs were anaesthetized and laminectomized at L3-L4. Microdialysis catheters were placed for sampling in the spinal cord, CSF, and epidural space. A single dose of 1500 mg cefuroxime was administered intravenously over 10 min. Microdialysates and plasma were obtained continuously during 8 h. Cefuroxime concentrations were determined by ultra-high-performance liquid chromatography. KEY RESULTS Mean fT > MIC (4 μg·ml-1 ) was 58 min in the spinal cord, 0 min in the CSF, 115 min in the epidural space, and 123 min in plasma. Tissue penetration was 32% in the spinal cord, 7% in the CSF, and 63% in the epidural space. CONCLUSION AND IMPLICATIONS fT > MIC (4 μg·ml-1 ) and tissue penetration for cefuroxime were lower in the intrathecal compartments (spinal cord and CSF) than in the extrathecal compartment (epidural space) and plasma, suggesting a significant effect of the blood-brain barrier. In terms of fT > MIC, a single dose of 1500 mg cefuroxime seems inadequate to prevent intrathecal infections related to spinal surgery for bacteria presenting with a MIC target of 4 μg· ml-1 or above.
Collapse
Affiliation(s)
- Alexander Emil Kaspersen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Pelle Hanberg
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Magnus A Hvistendahl
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Mats Bue
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Vibeke Schmedes
- Department of Clinical Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark
| | - Kristian Høy
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
3
|
De Sutter PJ, De Cock P, Johnson TN, Musther H, Gasthuys E, Vermeulen A. Predictive Performance of Physiologically Based Pharmacokinetic Modelling of Beta-Lactam Antibiotic Concentrations in Adipose, Bone, and Muscle Tissues. Drug Metab Dispos 2023; 51:499-508. [PMID: 36639242 DOI: 10.1124/dmd.122.001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Physiologically based pharmacokinetic (PBPK) models consist of compartments representing different tissues. As most models are only verified based on plasma concentrations, it is unclear how reliable associated tissue profiles are. This study aimed to assess the accuracy of PBPK-predicted beta-lactam antibiotic concentrations in different tissues and assess the impact of using effect site concentrations for evaluation of target attainment. Adipose, bone, and muscle concentrations of five beta-lactams (piperacillin, cefazolin, cefuroxime, ceftazidime, and meropenem) in healthy adults were collected from literature and compared with PBPK predictions. Model performance was evaluated with average fold errors (AFEs) and absolute AFEs (AAFEs) between predicted and observed concentrations. In total, 26 studies were included, 14 of which reported total tissue concentrations and 12 unbound interstitial fluid (uISF) concentrations. Concurrent plasma concentrations, used as baseline verification of the models, were fairly accurate (AFE: 1.14, AAFE: 1.50). Predicted total tissue concentrations were less accurate (AFE: 0.68, AAFE: 1.89). A slight trend for underprediction was observed but none of the studies had AFE or AAFE values outside threefold. Similarly, predictions of microdialysis-derived uISF concentrations were less accurate than plasma concentration predictions (AFE: 1.52, AAFE: 2.32). uISF concentrations tended to be overpredicted and two studies had AFEs and AAFEs outside threefold. Pharmacodynamic simulations in our case showed only a limited impact of using uISF concentrations instead of unbound plasma concentrations on target attainment rates. The results of this study illustrate the limitations of current PBPK models to predict tissue concentrations and the associated need for more accurate models. SIGNIFICANCE STATEMENT: Clinical inaccessibility of local effect site concentrations precipitates a need for predictive methods for the estimation of tissue concentrations. This is the first study in which the accuracy of PBPK-predicted tissue concentrations of beta-lactam antibiotics in humans were assessed. Predicted tissue concentrations were found to be less accurate than concurrent predicted plasma concentrations. When using PBPK models to predict tissue concentrations, this potential relative loss of accuracy should be acknowledged when clinical tissue concentrations are unavailable to verify predictions.
Collapse
Affiliation(s)
- Pieter-Jan De Sutter
- Laboratory of Medical Biochemistry and Clinical Analysis, Department of Bioanalysis, Faculty of Pharmaceutical Sciences (P-J.DS., E.G., A.V.), Department of Basic and Applied Medical Science, Faculty of Medicine and Health Sciences (P.D-C), Ghent University, Ghent, Belgium; Department of Pharmacy and Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium (P.D-C.); and Certara UK Limited, Sheffield, United Kingdom (T.N.J., H.M.)
| | - Pieter De Cock
- Laboratory of Medical Biochemistry and Clinical Analysis, Department of Bioanalysis, Faculty of Pharmaceutical Sciences (P-J.DS., E.G., A.V.), Department of Basic and Applied Medical Science, Faculty of Medicine and Health Sciences (P.D-C), Ghent University, Ghent, Belgium; Department of Pharmacy and Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium (P.D-C.); and Certara UK Limited, Sheffield, United Kingdom (T.N.J., H.M.)
| | - Trevor N Johnson
- Laboratory of Medical Biochemistry and Clinical Analysis, Department of Bioanalysis, Faculty of Pharmaceutical Sciences (P-J.DS., E.G., A.V.), Department of Basic and Applied Medical Science, Faculty of Medicine and Health Sciences (P.D-C), Ghent University, Ghent, Belgium; Department of Pharmacy and Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium (P.D-C.); and Certara UK Limited, Sheffield, United Kingdom (T.N.J., H.M.)
| | - Helen Musther
- Laboratory of Medical Biochemistry and Clinical Analysis, Department of Bioanalysis, Faculty of Pharmaceutical Sciences (P-J.DS., E.G., A.V.), Department of Basic and Applied Medical Science, Faculty of Medicine and Health Sciences (P.D-C), Ghent University, Ghent, Belgium; Department of Pharmacy and Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium (P.D-C.); and Certara UK Limited, Sheffield, United Kingdom (T.N.J., H.M.)
| | - Elke Gasthuys
- Laboratory of Medical Biochemistry and Clinical Analysis, Department of Bioanalysis, Faculty of Pharmaceutical Sciences (P-J.DS., E.G., A.V.), Department of Basic and Applied Medical Science, Faculty of Medicine and Health Sciences (P.D-C), Ghent University, Ghent, Belgium; Department of Pharmacy and Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium (P.D-C.); and Certara UK Limited, Sheffield, United Kingdom (T.N.J., H.M.)
| | - An Vermeulen
- Laboratory of Medical Biochemistry and Clinical Analysis, Department of Bioanalysis, Faculty of Pharmaceutical Sciences (P-J.DS., E.G., A.V.), Department of Basic and Applied Medical Science, Faculty of Medicine and Health Sciences (P.D-C), Ghent University, Ghent, Belgium; Department of Pharmacy and Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium (P.D-C.); and Certara UK Limited, Sheffield, United Kingdom (T.N.J., H.M.)
| |
Collapse
|
4
|
HVISTENDAHL MA, HANBERG P, STILLING M, KASPERSEN AE, HØY K, BUE M. Subtherapeutic levels of cefuroxime inside a cannulated pedicle screw used in spine surgery: results from a porcine microdialysis study. Acta Orthop 2022; 93:874-879. [PMID: 36445157 PMCID: PMC9707378 DOI: 10.2340/17453674.2022.5276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND PURPOSE Minimally invasive spine surgery has continuously evolved for specific surgical procedures and patient populations to lower morbidity and the risk of postoperative bacterial infection. Perioperative antibiotic prophylaxis is an important preventive measure and local tissue concentrations can be quantified with microdialysis. Insertion of spinal implants induces tissue trauma and inflammation, which may affect antibiotic proximate implant concentrations. We compared perioperative cefuroxime concentrations inside a cannulated pedicle screw used in minimally invasive spine surgery with the opposite non-instrumented vertebral pedicle. MATERIALS AND METHODS Microdialysis catheters were placed inside a cannulated pedicle screw and in the opposite non-instrumented vertebral pedicle of the same vertebra (L1) in 8 female pigs through a posterior lumbar surgical approach. Following a single-dose intravenous cefuroxime administration (1.5 g), dialysates and plasma were dynamically sampled over 8 hours. The primary endpoint was time above the cefuroxime clinical breakpoint minimal inhibitory concentration for Staphylococcus aureus of 4 μg/mL (T>MIC4). RESULTS Median T>MIC4 was 0 h (range 0-0) inside the cannulated pedicle screw, 1.6 h (range 1.1-2.4) in non-instrumented vertebral pedicle, and 1.9 h (range 1.9-2.9) in plasma. CONCLUSION A single-dose intravenous cefuroxime administration provided low and subtherapeutic concentrations for prevention of infection inside a cannulated pedicle screw in the lumbar spine. Therapeutic concentrations were achieved in the opposite non-instrumented vertebral pedicle up to 1.5-2 h. Therefore, additional prophylactic strategies may be considered in cannulated instrumented spine surgery, especially in high-risk patients. Alternative dosing regimens seem relevant in lumbar spine surgery lasting longer than 1.5 h.
Collapse
Affiliation(s)
- Magnus A HVISTENDAHL
- Department of Clinical Medicine, Aarhus University, Aarhus N,Aarhus Denmark Microdialysis Research (ADMIRE), Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus N
| | - Pelle HANBERG
- Department of Clinical Medicine, Aarhus University, Aarhus N,Aarhus Denmark Microdialysis Research (ADMIRE), Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus N
| | - Maiken STILLING
- Department of Clinical Medicine, Aarhus University, Aarhus N,Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Kristian HØY
- Department of Clinical Medicine, Aarhus University, Aarhus N,Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Mats BUE
- Department of Clinical Medicine, Aarhus University, Aarhus N,Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|
5
|
Hvistendahl MA, Bue M, Hanberg P, Kaspersen AE, Schmedes AV, Stilling M, Høy K. Cefuroxime concentrations in the anterior and posterior column of the lumbar spine - an experimental porcine study. Spine J 2022; 22:1434-1441. [PMID: 35671945 DOI: 10.1016/j.spinee.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/04/2022] [Accepted: 05/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical site infection following spine surgery is associated with increased morbidity and mortality. Perioperative antibiotic prophylaxis is a key factor in lowering the risk of acquiring an infection. Previous studies have assessed perioperative cefuroxime concentrations in the anterior column of the cervical spine with an anterior surgical approach. However, the majority of surgeries are performed in the posterior column and many surgeries involve the lumbar spine. PURPOSE The objective of this study was to compare the perioperative tissue concentrations of cefuroxime in the anterior and posterior column during lumbar spine surgery with a posterior surgical approach. STUDY DESIGN In vivo experimental pharmacokinetic study of cefuroxime concentrations in an acute preclinical porcine model. METHODS The lumbar vertebral column was exposed from L1 to L5 in 8 female pigs. Microdialysis catheters were placed for sampling in the anterior column (vertebral body) and posterior column (posterior arch) within the same vertebra (L5). Cefuroxime (1.5 g) was administered intravenously. Microdialysates and plasma samples were continuously obtained over 8 hours. Cefuroxime concentrations were quantified by Ultra High Performance Liquid Chromatography Tandem Mass Spectrometry. The primary endpoint was the time above the cefuroxime clinical breakpoint minimal inhibitory concentration (T>MIC) for Staphylococcus aureus of 4 µg/mL. The secondary endpoint was tissue penetration (AUCtissue/AUCplasma). RESULTS Mean T>MIC 4 µg/mL (95% confidence interval) was 123 min (105-141) in plasma, 97 min (79-115) in the anterior column and 93 min (75-111) in the posterior column. Tissue penetration (95% confidence interval) was incomplete for both the anterior column 0.48 (0.40-0.56) and posterior column 0.40 (0.33-0.48). CONCLUSIONS T>MIC was comparable between the anterior and posterior column. Mean cefuroxime concentrations decreased below the clinical breakpoint minimal inhibitory concentration for S. aureus of 4 µg/mL after 123 minutes (plasma), 97 minutes (anterior column) and 93 minutes (posterior column). This is shorter than the duration of most lumbar spine surgeries, and therefore alternative dosing regimens should be considered in posterior open lumbar spine surgeries lasting more than 1.5 hours. CLINICAL SIGNIFICANCE Open lumbar spine surgery often involves extensive soft tissue dissection, stripping and retraction of the paraspinal muscles which may impair the local blood flow exposing the lumbar vertebra to postoperative infections. A single intravenous administration of 1.5 g cefuroxime only provided sufficient prophylactic target tissue concentrations in the vertebra of the lumbar spine for up to 1.5 hours.
Collapse
Affiliation(s)
- Magnus A Hvistendahl
- Department of Clinical Medicine, Aarhus University, Aarhus N, Central Denmark Region, Denmark; Aarhus Denmark Microdialysis Research (ADMIRE), Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus N, Central Denmark Region, Denmark.
| | - Mats Bue
- Department of Clinical Medicine, Aarhus University, Aarhus N, Central Denmark Region, Denmark; Aarhus Denmark Microdialysis Research (ADMIRE), Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus N, Central Denmark Region, Denmark; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Central Denmark Region, Denmark
| | - Pelle Hanberg
- Department of Clinical Medicine, Aarhus University, Aarhus N, Central Denmark Region, Denmark; Aarhus Denmark Microdialysis Research (ADMIRE), Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus N, Central Denmark Region, Denmark
| | - Alexander Emil Kaspersen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Central Denmark Region, Denmark; Aarhus Denmark Microdialysis Research (ADMIRE), Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus N, Central Denmark Region, Denmark
| | - Anne Vibeke Schmedes
- Department of Clinical Biochemistry and Immunology, Hospital Lillebaelt, Vejle, Southern Denmark Region, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus N, Central Denmark Region, Denmark; Aarhus Denmark Microdialysis Research (ADMIRE), Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus N, Central Denmark Region, Denmark; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Central Denmark Region, Denmark
| | - Kristian Høy
- Department of Clinical Medicine, Aarhus University, Aarhus N, Central Denmark Region, Denmark; Aarhus Denmark Microdialysis Research (ADMIRE), Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus N, Central Denmark Region, Denmark; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus N, Central Denmark Region, Denmark
| |
Collapse
|
6
|
Koch BCP, Zhao Q, Oosterhoff M, van Oldenrijk J, Abdulla A, de Winter BCM, Bos K, Muller AE. The mysteries of target site concentrations of antibiotics in bone and joint infections: what is known? A narrative review. Expert Opin Drug Metab Toxicol 2022; 18:587-600. [PMID: 36008360 DOI: 10.1080/17425255.2022.2117607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Currently, antibiotic treatment is often a standard dosing regimen in bone and joint infections (BJI). However, it remains unknown if exposure at the target-site is adequate. The aim of this review is to gain more insight in the relationship between the target site concentration of antibiotic and the minimal inhibitory concentration to target the bacteria in bone and joint infections (BJI). AREAS COVERED A literature search was performed by Erasmus MC Medical library. Bone, bone tissue and synovial concentration of antibiotics were covered in humans. In addition, we reported number of patients, dose, sampling method, analytical method and tissue and plasma concentrations. We used the epidemiological cut-off value (ECOFF) values of the targeted micro-organisms. If more than 3 publications were available on the antibiotic, we graphically presented ECOFFS values against reported antibiotic concentrations. EXPERT OPINION For most antibiotics the literature is sparse. In addition, a lot of variable and total antibiotic concentrations are published. Ciprofloxacin, cefazolin, cefuroxime, vancomycin and linezolid seem to have adequate average exposure if correlating total concentration to ECOFF, when standard dosing is used. With regards to other antibiotics, results are inconclusive. More extensive pharmacokinetic/pharmacodynamic modeling in BJI is needed.
Collapse
Affiliation(s)
- Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,CATOR, Center for Antimicrobial Optimized Treatment Rotterdam.,Rotterdam Clinical Pharmacometrics Group
| | - Qiaolin Zhao
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,Rotterdam Clinical Pharmacometrics Group
| | - Maartje Oosterhoff
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jakob van Oldenrijk
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alan Abdulla
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,CATOR, Center for Antimicrobial Optimized Treatment Rotterdam.,Rotterdam Clinical Pharmacometrics Group
| | - Brenda C M de Winter
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,CATOR, Center for Antimicrobial Optimized Treatment Rotterdam.,Rotterdam Clinical Pharmacometrics Group
| | - Koen Bos
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anouk E Muller
- CATOR, Center for Antimicrobial Optimized Treatment Rotterdam.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Medical Microbiology, Haaglanden Medisch Centrum, The Hague, the Netherlands
| |
Collapse
|
7
|
Application of a Physiologically Based Pharmacokinetic Model to Predict Cefazolin and Cefuroxime Disposition in Obese Pregnant Women Undergoing Caesarean Section. Pharmaceutics 2022; 14:pharmaceutics14061162. [PMID: 35745736 PMCID: PMC9229966 DOI: 10.3390/pharmaceutics14061162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 12/10/2022] Open
Abstract
Intravenous (IV) cefuroxime and cefazolin are used prophylactically in caesarean sections (CS). Currently, there are concerns regarding sub-optimal dosing in obese pregnant women compared to lean pregnant women prior to CS. The current study used a physiologically based pharmacokinetic (PBPK) approach to predict cefazolin and cefuroxime pharmacokinetics in obese pregnant women at the time of CS as well as the duration that these drug concentrations remain above a target concentration (2, 4 or 8 µg/mL or µg/g) in plasma or adipose tissue. Cefazolin and cefuroxime PBPK models were first built using clinical data in lean and in obese non–pregnant populations. Models were then used to predict cefazolin and cefuroxime pharmacokinetics data in lean and obese pregnant populations. Both cefazolin and cefuroxime models sufficiently described their total and free levels in the plasma and in the adipose interstitial fluid (ISF) in non–pregnant and pregnant populations. The obese pregnant cefazolin model predicted adipose exposure adequately at different reference time points and indicated that an IV dose of 2000 mg can maintain unbound plasma and adipose ISF concentration above 8 µg/mL for 3.5 h post dose. Predictions indicated that an IV 1500 mg cefuroxime dose can achieve unbound plasma and unbound ISF cefuroxime concentration of ≥8 µg/mL up to 2 h post dose in obese pregnant women. Re-dosing should be considered if CS was not completed within 2 h post cefuroxime administration for both lean or obese pregnant if cefuroxime concentrations of ≥8 µg/mL is required. A clinical study to measure cefuroxime adipose concentration in pregnant and obese pregnant women is warranted.
Collapse
|
8
|
Tøstesen SK, Stilling M, Hanberg P, Thillemann TM, Falstie-Jensen T, Tøttrup M, Knudsen M, Petersen ET, Bue M. High Cefuroxime Concentrations and Long Elimination in an Orthopaedic Surgical Deadspace—A Microdialysis Porcine Study. Antibiotics (Basel) 2022; 11:antibiotics11020208. [PMID: 35203810 PMCID: PMC8868149 DOI: 10.3390/antibiotics11020208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
Deadspace is the tissue and bony defect in a surgical wound after closure. This space is presumably poorly perfused favouring bacterial proliferation and biofilm formation. In arthroplasty surgery, an obligate deadspace surrounding the prosthesis is introduced and deadspace management, in combination with obtaining therapeutic prophylactic antibiotic concentrations, is important for limiting the risk of acquiring a periprosthetic joint infection (PJI). This study aimed to investigate cefuroxime distribution to an orthopaedic surgical deadspace in comparison with plasma and bone concentrations during two dosing intervals (8 h × 2). In a setup imitating shoulder arthroplasty surgery, but without insertion of a prosthesis, microdialysis catheters were placed for cefuroxime sampling in a deadspace in the glenohumeral joint and in cancellous bone of the scapular neck in eighteen pigs. Blood samples were collected as a reference. Cefuroxime was administered according to weight (20 mg/kg). The primary endpoint was time above the cefuroxime minimal inhibitory concentration of the free fraction of cefuroxime for Staphylococcus aureus (fT > MIC (4 μg/mL)). During the two dosing intervals, mean fT > MIC (4 μg/mL) was significantly longer in deadspace (605 min) compared with plasma (284 min) and bone (334 min). For deadspace, the mean time to reach 4 μg/mL was prolonged from the first dosing interval (8 min) to the second dosing interval (21 min), while the peak drug concentration was lower and half-life was longer in the second dosing interval. In conclusion, weight-adjusted cefuroxime fT > MIC (4 μg/mL) and elimination from the deadspace was longer in comparison to plasma and bone. Our results suggest a deadspace consolidation and a longer diffusions distance, resulting in a low cefuroxime turn-over. Based on theoretical targets, cefuroxime appears to be an appropriate prophylactic drug for the prevention of PJI.
Collapse
Affiliation(s)
- Sara Kousgaard Tøstesen
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, 8200 Aarhus N, Denmark; (M.S.); (P.H.); (M.B.)
- Department of Orthopaedic Surgery, Aarhus University Hospital, 8200 Aarhus N, Denmark; (T.M.T.); (T.F.-J.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark; (M.K.); (E.T.P.)
- Correspondence:
| | - Maiken Stilling
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, 8200 Aarhus N, Denmark; (M.S.); (P.H.); (M.B.)
- Department of Orthopaedic Surgery, Aarhus University Hospital, 8200 Aarhus N, Denmark; (T.M.T.); (T.F.-J.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark; (M.K.); (E.T.P.)
- AutoRSA Research Group, Orthopaedic Research Laboratory, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Pelle Hanberg
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, 8200 Aarhus N, Denmark; (M.S.); (P.H.); (M.B.)
| | - Theis Muncholm Thillemann
- Department of Orthopaedic Surgery, Aarhus University Hospital, 8200 Aarhus N, Denmark; (T.M.T.); (T.F.-J.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark; (M.K.); (E.T.P.)
| | - Thomas Falstie-Jensen
- Department of Orthopaedic Surgery, Aarhus University Hospital, 8200 Aarhus N, Denmark; (T.M.T.); (T.F.-J.)
| | - Mikkel Tøttrup
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9640 Farsoe, Denmark;
| | - Martin Knudsen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark; (M.K.); (E.T.P.)
| | - Emil Toft Petersen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark; (M.K.); (E.T.P.)
- AutoRSA Research Group, Orthopaedic Research Laboratory, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Mats Bue
- Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Laboratory, Aarhus University Hospital, 8200 Aarhus N, Denmark; (M.S.); (P.H.); (M.B.)
- Department of Orthopaedic Surgery, Aarhus University Hospital, 8200 Aarhus N, Denmark; (T.M.T.); (T.F.-J.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark; (M.K.); (E.T.P.)
| |
Collapse
|
9
|
Tøstesen SK, Hanberg P, Bue M, Thillemann TM, Falstie-Jensen T, Tøttrup M, Knudsen MB, Schmedes AV, Stilling M. Weight-based cefuroxime dosing provides comparable orthopedic target tissue concentrations between weight groups - a microdialysis porcine study. APMIS 2021; 130:111-118. [PMID: 34862642 DOI: 10.1111/apm.13198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022]
Abstract
Antibiotic prophylaxis is a key element in prevention of surgical site infections. For the majority of orthopedic procedures, antibiotic administration follows fixed dosing regimens irrespective of weight. However, this may result in insufficient antibiotic target tissue concentrations and higher risk of surgical site infections in obese individuals. The aim of this study was to investigate the effect of weight-based cefuroxime dosing on plasma and target tissue concentrations. Eighteen female pigs were allocated into three groups differentiated by weight: 53-57 kg, 73-77 kg, and 93-97 kg. Microdialysis catheters were placed for continuous sampling in bone, muscle, and subcutaneous tissue during an 8h sampling interval. Blood samples were collected as reference. Cefuroxime was administered intravenously as a bolus according to weight (20 mg/kg). The primary endpoint was the time above the cefuroxime minimal inhibitory concentration for Staphylococcus aureus (T > MIC (4 μg/mL)). Comparable target tissue T > MICs (4 μg/mL) were found between weight groups. Mean T > MIC ranged between 116-137 min for plasma, 118-154 min for bone, 109-146 min for the skeletal muscle, and 117-165 min for subcutaneous tissue across the groups. Weight-based cefuroxime (20 mg/kg) dosing approach provides comparable perioperative plasma and target tissue T > MIC (4 μg/mL) in animals between 50-100 kg body weight, and thus a comparable prophylaxis of surgical site infections.
Collapse
Affiliation(s)
- Sara Kousgaard Tøstesen
- Aarhus Microdialysis Research Group, Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Pelle Hanberg
- Aarhus Microdialysis Research Group, Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Mats Bue
- Aarhus Microdialysis Research Group, Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Theis Muncholm Thillemann
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Mikkel Tøttrup
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Maiken Stilling
- Aarhus Microdialysis Research Group, Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|