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Sungmin Kiem,Jerome J. Schentag 대한감염학회 2014 Infection and Chemotherapy Vol.46 No.4
Although antibiotics whose epithelial lining fluid (ELF) concentrations are reported high tend to be preferred in treatment ofpneumonia, measurement of ELF concentrations of antibiotics could be misled by contamination from lysis of ELF cells andtechnical errors of bronchoalveolar lavage (BAL). In this review, ELF concentrations of anti-methicillin resistant Staphylococcusaureus (MRSA) antibiotics were interpreted considering above confounding factors. An equation used to explain antibiotic diffusioninto CSF (cerebrospinal fluid) was adopted: ELF/free serum concentration ratio = 0.96 + 0.091 × ln (partition coefficient/ molecular weight1/2). Seven anti-MRSA antibiotics with reported ELF concentrations were fitted to this equation to see if theirELF concentrations were explainable by the penetration capacity only. Then, outliers were modeled under the assumption ofvarying contamination from lysed ELF cells (test range 0-10% of ELF volume). ELF concentrations of oritavancin, telavancin,tigecycline, and vancomycin were well described by the diffusion equation, with or without additional impact from cell lysis. For modestly high ELF/free serum concentration ratio of linezolid, technical errors of BAL should be excluded. Although teicoplaninand iclaprim showed high ELF/free serum ratios also, their protein binding levels need to be cleared for proper interpretation. At the moment, it appears very premature to use ELF concentrations of anti-MRSA antibiotics as a relevant guide fortreatment of lung infections by MRSA.