An Observation on Vancomycin Concentrations in Cerebrospinal Fluid and Serum of a Chinese Critically-Ill Patient with Intravenous Drug Injection
Background: The blood-brain-barrier (BBB), which is characterized with the selective permeability, has major impact on distribution, concentration and biological effects of most drugs in the central nervous system (CNS).
Methods: In this study, we chose one critically-ill patient in year 2015 and monitored drug concentrations in the cerebrospinal fluid (CSF) and serum during vancomycin therapy, in order to observe vancomycin permeability of BBB or clinical application potential under CNS infection state.
Results: During a period of 48h after intravenous drug injection, the peak level was 3.45 µg/ml, lowest level 0.13 µg/ml, and average level 1.46 µg/ml in the CSF. In the serum, the peak level was 64.23 µg/ml, lowest level 3.91 µg/ml and average level 21.56 µg/ml. In all nine time-points detected during 48h, CSF drug concentrations were lower than that in serum, but CSF drug levels in six of nine time-points showed above MIC (1.0 µg/ml) or effective for MRSA, indicating that BBB had larger influence on drug permeability or distribution of vancomycin in the CNS. However, intravenous injection could reach concentration effective for MASA of CNS infection.
Conclusions: This was difficult to obtain case and it has provided new evidence on vancomycin usage in CNS for MASA infections in a Chinese critically-ill patient.