Does Sex Also Influence Antibiotic Penetration Into Presternal Subcutaneous Tissue?

Abstract

We have read the great article by Andreas and colleagues [1Andreas M. Zeitlinger M. Hoeferl M. et al.Internal mammary artery harvesting influences antibiotic penetration into presternal tissue.Ann Thorac Surg. 2013; 95: 1323-1330Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar], which showed that harvesting of the internal mammary artery impaired local antibiotic penetration during coronary artery bypass grafting. In their research, the authors measured antibiotic penetration into presternal subcutaneous tissue with microdialysis probes in 2 female and 6 male patients [1Andreas M. Zeitlinger M. Hoeferl M. et al.Internal mammary artery harvesting influences antibiotic penetration into presternal tissue.Ann Thorac Surg. 2013; 95: 1323-1330Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar]. We were curious to see whether there are sex differences in antibiotic penetration patterns. On average, total body water, extracellular water, intracellular water, total blood volume, plasma volume, and red blood cell volume are greater in male individuals [2Soldin O.P. Chung S.H. Mattison D.R. Sex differences in drug disposition.J Biomed Biotechnol. 2011; 2011 (Epub 2011 Feb 23): 187103doi:10.1155/2011/187103Crossref PubMed Scopus (179) Google Scholar]. Therefore, if an average adult man and an average adult woman are exposed to the same dose of a water-soluble drug, the volume of distribution will be increased in the man, thus decreasing drug concentration [2Soldin O.P. Chung S.H. Mattison D.R. Sex differences in drug disposition.J Biomed Biotechnol. 2011; 2011 (Epub 2011 Feb 23): 187103doi:10.1155/2011/187103Crossref PubMed Scopus (179) Google Scholar]. Blood distribution and regional blood flow, which affect pharmacokinetics, are different between male and female individuals [2Soldin O.P. Chung S.H. Mattison D.R. Sex differences in drug disposition.J Biomed Biotechnol. 2011; 2011 (Epub 2011 Feb 23): 187103doi:10.1155/2011/187103Crossref PubMed Scopus (179) Google Scholar]. Blood flow to skeletal muscle is greater in male individuals, whereas blood flow to adipose tissue is greater in female individuals [2Soldin O.P. Chung S.H. Mattison D.R. Sex differences in drug disposition.J Biomed Biotechnol. 2011; 2011 (Epub 2011 Feb 23): 187103doi:10.1155/2011/187103Crossref PubMed Scopus (179) Google Scholar]. Body composition is also different; body fat as a percentage of total body weight is higher in women than in men [2Soldin O.P. Chung S.H. Mattison D.R. Sex differences in drug disposition.J Biomed Biotechnol. 2011; 2011 (Epub 2011 Feb 23): 187103doi:10.1155/2011/187103Crossref PubMed Scopus (179) Google Scholar, 3Young C.M. Tensuan R.S. Estimating the lean body mass of young women: use of skeletal measurements.J Am Diet Assoc. 1963; 42: 46-51PubMed Google Scholar]. All the aforementioned parameters affect drug distribution. We thought that sex differences might lead to differences in antibiotic penetration because drug distribution differs by sex. In addition, Andreas and colleagues measured antibiotic penetration in the subcutaneous tissue, where the regional flow differs between male and female individuals. In conclusion, we ask whether the patterns of antibiotic penetration into subcutaneous tissue were different between male and female patients. Internal Mammary Artery Harvesting Influences Antibiotic Penetration Into Presternal TissueThe Annals of Thoracic SurgeryVol. 95Issue 4PreviewInternal mammary artery (IMA) harvesting for coronary artery bypass grafting (CABG) influences tissue perfusion and represents a risk factor for deep sternal wound infection (DSWI). Cephalosporins are routinely administered for prophylaxis during cardiac operations to decrease perioperative wound infections. We hypothesized that mammary artery preparation impairs antibiotic penetration into presternal tissue during CABG. Full-Text PDF ReplyThe Annals of Thoracic SurgeryVol. 96Issue 4PreviewWe want to thank Son and colleagues [1] for their interest in our data [2] and their important question. We share their opinion that gender differences might have a significant but multifactorial role in the prevention, development, and therapy of surgical site infections. We recently demonstrated a significantly increased risk for leg wound infections after vein harvesting for coronary artery bypass grafting in female patients (odds ratio 2.4; p = 0.001) [3]. Full-Text PDF