Pharmacokinetics and tissue penetration of vancomycin continuous infusion as prophylaxis for vascular surgery

OBJECTIVES: To determine the tissue penetration of vancomycin into perivascular fat and arterial wall during a continuous infusion of vancomycin, given as prophylaxis for vascular surgery. PATIENTS AND METHODS: Patients undergoing arterial reconstruction requiring antibiotic prophylaxis were included. Patients received a loading infusion of vancomycin the evening prior to surgery followed by a continuous 24 h infusion, calculated according to renal function. Three peri-operative serum samples and intra-operative perivascular fat and arterial wall samples were collected for vancomycin assay. RESULTS: Twenty-eight patients were included. Three serum samples were obtained from all patients, fat samples were available from 27 (96.4%) patients and vessel wall samples were available from 23 (82.1%) patients. Serum vancomycin concentrations were maintained within a relatively narrow range, while fat and arterial wall concentrations were highly variable. CONCLUSIONS: This study has shown that prophylactic administration of vancomycin with a loading infusion followed by a continuous infusion before and during vascular surgery achieves serum and vascular tissue concentrations that are above the MICs for most common organisms implicated in post-operative graft infection. However, penetration into perivascular fat tissues is poor.