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Antimicrobial Agents and Chemotherapy, December 2005, p. 5107-5111, Vol. 49, No. 12
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.12.5107-5111.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

In Vivo Measurement of Levofloxacin Penetration into Lung Tissue after Cardiac Surgery

Department of Cardiothoracic and Vascular Anaesthesia & Clinical Care Medicine, University of Vienna, General Hospital, Vienna, Austria,¹ Department of Clinical Pharmacology, University of Vienna, General Hospital, Vienna, Austria,² Department of Cardiothoracic Surgery, University of Vienna, General Hospital, Vienna, Austria,³ Department of Infectious Diseases, University of Vienna, General Hospital, Vienna, Austria⁴

Received 24 August 2004/ Returned for modification 25 January 2005/ Accepted 6 July 2005

Nosocomial pneumonia is a severe complication after cardiac surgery (CS). Levofloxacin, a fluoroquinolone, qualifies for the therapy of postoperative pneumonia. However, penetration properties of levofloxacin into the lung tissue could be substantially affected by CS: atelectasis, low cardiac output after CS, high volume loads, and inflammatory capillary leak potentially influence drug distribution. The aim of our study was to gain information on interstitial antibiotic concentrations in lung tissue in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. Therefore, six patients undergoing elective CS participated in this prospective study. A dose of 500 mg of levofloxacin was administered intravenously in addition to standard antibiotic prophylaxis immediately after the end of surgery. Time versus concentration profiles of levofloxacin in the interstitial lung tissue and plasma were determined. A microdialysis technique was used for lung interstitial concentration measurements. The microdialysis procedure was well tolerated in all patients and no adverse events were observed. The median area under the concentration curve (AUC) of levofloxacin in interstitial lung fluid was 18.6 µg · h/ml (range, 10.1 to 33.6). The median AUC for tissue (AUC_tissue) of unbound levofloxacin/AUC_total in plasma was 0.6 (range, 0.4 to 0.9). The median unbound AUC_tissue/MIC was 2.4 (range, 1.3 to 4.2) for Pseudomonas aeruginosa. Our study demonstrated the feasibility and safety of microdialysis in human lung tissue in vivo after CS. The unbound AUC/MIC ratio revealed that levofloxacin used in the described manner was borderline sufficient for the treatment of nosocomial pneumonia caused by Klebsiella pneumoniae and insufficient for the treatment of pneumonia caused by Pseudomonas aeruginosa, because the breakpoint of 30 to 40 for AUC/MIC could not be reached by the conventionally used dosage schema in our post-CS setting. Penetration was lower than in previous reports.

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