Antibiotic Levels in the Human Serum, Pericardial Fluid and Heart Tissues

Abstract

One of the most frequently occurring complications following heart interventions is infection. This may have the form of wound infection, respiratory, or urinary infections; however, its most frequent form is postoperative endocarditis. According to Rapaport (9), it is an ironic situation that one of the therapeutic possibilities for bacterial endocarditis is just the prosthetic valve replacement. Antibiotics are essential tools in prevention and therapy of postoperative infections and bacterial endocarditis. Antibiotic therapy may be succesful if the bacteria involved in the disease are susceptible to the antibiotic applied. This basic principle has been known for several decades. Nevertheless, the therapeutic failures and the new results of clinical pharmacology revealed that apart from the principle cited above, we shall have success only if, apart from the serum, the antibiotics reach an efficient concentration even at the place of the disease, i.e., in the tissues. The tissue levels are sufficient if they reach or superate the minimal inhibitory concentration for the given bacteria. Therefore, the knowledge of the tissue levels is of even higher importance from a clinical point of view than that of the serum levels. The most effective antibiotic, the dosage, and mode of application can only be properly selected for a given infection if we know exactly the actual tissue levels. In order to meet these requirements, we studied the antibiotic levels in the serum, the pericaridal fluid, the auricle, and cardiac valves during heart operations.