Correlation between vancomycin penetration into cerebrospinal fluid and protein concentration in cerebrospinal fluid/serum albumin ratio
Correlation between vancomycin penetration into cerebrospinal fluid and protein concentration in cerebrospinal fluid/serum albumin ratio
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DOI：
10.1016/j.jiac.2018.10.013
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发表时间：
2019-02-01
影响因子：
2.2
通讯作者：
Ishii, Itsuko
中科院分区：
文献类型：
--
作者：
Ishikawa, Masayuki;Yamazaki, Shingo;Ishii, Itsuko
细菌性脑膜炎是一种危及生命的疾病。万古霉素（VCM）是一种用于细菌性脑膜炎经验治疗的抗生素。维持脑脊液 (CSF) 中足够的 VCM 浓度对于有效治疗细菌性脑膜炎至关重要。静脉注射的 VCM 必须通过血脑屏障 (BBB) 才能进入 CSF，并且 VCM 渗透到 CSF 的程度因患者而异。先前的报告表明，脑脊液白蛋白水平可用于估计 VCM 脑脊液渗透率。然而，在常规实践中并不测量脑脊液白蛋白水平。我们重点关注在细菌性脑膜炎的诊断和治疗开始时通常检查的脑脊液蛋白浓度。我们检查了脑脊液蛋白浓度/血清白蛋白比率与 VCM 渗透到脑脊液的程度之间的关系。这项回顾性研究涉及 7 名因疑似细菌性脑膜炎而入院接受 VCM 治疗的患者。血清和脑脊液中的VCM浓度分别为17.6+/-7.2μg/mL和3.31+/-3.14μg/mL。血清VCM浓度与脑脊液VCM浓度无显着相关性。另一方面，CSF/血清白蛋白比率中的蛋白质浓度与VCM CSF/血清比率呈强正相关（r = 0.877，p < 0.005）。我们的研究表明，CSF 蛋白浓度/血清白蛋白的比率可能有助于估计 VCM CSF/血清的近似比率。这可能有助于改善细菌性脑膜炎的治疗。 (c) 2018 年日本化疗学会和日本传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Bacterial meningitis is a life-threatening condition. Vancomycin (VCM) is one of the antibiotics used as empirical therapy for bacterial meningitis. It is essential to maintain an adequate concentration of VCM in cerebrospinal fluid (CSF) to treat bacterial meningitis effectively. VCM administered intravenously must pass the blood-brain barrier (BBB) to enter the CSF and the extent of VCM penetration into CSF varies widely among patients. Previous report indicated that CSF albumin level is useful for estimation of VCM CSF penetration. However, CSF albumin level is not measured in routine practice. We focused on CSF protein concentration that is generally examined at the beginning of diagnosis and treatment of bacterial meningitis. We examined the relationship between CSF protein concentration/serum albumin ratio and the extent of VCM penetration into CSF.This retrospective study involved 7 patients admitted to our hospital who were treated with VCM for suspected bacterial meningitis. The VCM concentrations in serum and CSF were 17.6 +/- 7.2 mu g/mL and 3.31 +/- 3.14 mu g/mL, respectively. The serum VCM concentrations showed no significant correlation with CSF VCM concentrations. On the other hand, the protein concentration in CSF/serum albumin ratio showed a strong positive correlation with the VCM CSF/serum ratio (r = 0.877, p < 0.005). Our study indicates that the ratio of CSF protein concentration/serum albumin is likely useful for estimating the approximate VCM CSF/serum ratio. This could contribute to an improvement in the treatment of bacterial meningitis. (c) 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.