BEHAVIOR OF ANTIBIOTICS DURING HUMAN NECROTIZING PANCREATITIS
BEHAVIOR OF ANTIBIOTICS DURING HUMAN NECROTIZING PANCREATITIS
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DOI：
10.1128/aac.38.4.830
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发表时间：
1994-04-01
影响因子：
4.9
通讯作者：
BERTAZZONI, EM
中科院分区：
文献类型：
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作者：
BASSI, C;PEDERZOLI, P;BERTAZZONI, EM
该研究的目的是验证正常胰腺分泌的抗生素是否也在人类坏死性胰腺炎中分泌，到达感染的组织部位。 12 例急性坏死性胰腺炎患者接受亚胺培南-西司他丁 (0.5 g)、美洛西林 (2 g)、庆大霉素 (0.08 g)、阿米卡星 (0.5 g)、培氟沙星 (0.4 g) 和甲硝唑 (0.5 g) 治疗。在肠外给药后，通过计算机断层扫描引导的针吸术、术中以及手术期间放置的手术引流管，在不同的时间间隔同时收集血清和坏死样本。通过微生物学和高效液相色谱分析测定药物浓度。所有抗生素均到达坏死组织，但渗透程度不同，氨基糖苷类的渗透程度较低（13%），而培氟沙星（89%）和甲硝唑（99%）的渗透程度较高。坏死样本中培氟沙星（13.0 至 23 微克/克）和甲硝唑（8.4 微克/克）的浓度明显高于该疾病中最常分离到的微生物的 MIC；亚胺培南（3.35 微克/克）和美洛西林（8.0 和 15.0 微克/克）在组织中的浓度并不总是超过 90% 测试菌株的 MIC，而坏死组织中的氨基糖苷类浓度（0.5 微克/克）则不足。重复给药（3、7、17和20天）似乎可以增强培氟沙星、亚胺培南和甲硝唑渗透到坏死的胰腺组织中。在坏死性胰腺炎期间预防感染性坏死的抗生素选择应基于其抗菌活性、渗透率、持久性和坏死胰腺区域的治疗浓度。这些必需品由培氟沙星和甲硝唑提供，并在不同程度上由亚胺培南和美洛西林提供。
The aim of the study was to verify whether antibiotics excreted by the normal pancreas are also excreted in human necrotizing pancreatitis, reaching the tissue sites of the infection. Twelve patients suffering from acute necrotizing pancreatitis were treated with imipenem-cilastatin (0.5 g), mezlocillin (2 g), gentamicin (0.08 g), amikacin (0.5 g), pefloxacin (0.4 g), and metronidazole (0.5 g). Serum and necrotic samples were collected simultaneously at different time intervals after parenteral drug administration by computed tomography-guided needle aspiration, intraoperatively, and from surgical drainages placed during surgery. Drug concentrations were determined by microbiological and high-performance liquid chromatography assays. All antibiotics reached the necrotic tissues, but with varying degrees of penetration, this being low for aminoglycosides (13%) and high in the case of pefloxacin (89%) and metronidazole (99%). The concentrations of pefloxacin (13.0 to 23 mug/g) and metronidazole (8.4 mug/g) in the necrotic samples were distinctly higher than the MICs for the organisms most commonly isolated in this disease; the concentrations in tissue of imipenem (3.35 mug/g) and mezlocillin (8.0 and 15.0 mug/g) did not always exceed the MICs for 90% of strains tested, whereas the aminoglycoside concentrations in necrotic tissue (0.5 mug/g) were inadequate. Repeated administration of drugs (for 3, 7, 17, and 20 days) seems to enhance penetration of pefloxacin, imipenem, and metronidazole into necrotic pancreatic tissue. The choice of antibiotics in preventing infected necrosis during necrotizing pancreatitis should be based on their antimicrobial activity, penetration rate, persistence, and therapeutic concentrations in the necrotic pancreatic area. These requisites are provided by pefloxacin and metronidazole and to a variable extent by imipenem and mezlocillin.