Background: Assuring adequate antibiotic tissue concentrations at the point of infection, especially in skin and soft tissue infections, is pivotal for an effective treatment and cure. Despite the global issue, a reliable AB monitoring test is missing. Inadequate antibiotic treatment leads to the development of antimicrobial resistances and toxic side effects. β-lactam antibiotics were already detected in sweat of patients treated with the respective antibiotics intravenously before. With the emergence of smartphone-based biosensors to analyse sweat on the spot of need, next-generation molecular digital biomarkers will be increasingly available for a non-invasive pharmacotherapy monitoring. Objective: Here, we investigated if the glycopeptide antibiotic vancomycin is detectable in sweat samples of in-patients treated with intravenous vancomycin. Methods: Eccrine sweat samples were collected using the Macroduct Sweat Collector®. Along every sweat sample, a blood sample was taken. Bio-fluid analysis was performed by Ultra-high Pressure Liquid Chromatograph-Tandem Quadrupole Mass Spectrometry coupled with tandem mass spectrometry. Results: A total of 5 patients were included. Results demonstrate that vancomycin was detected in 5 out of 5 sweat samples. Specifically, vancomycin concentrations ranged from 0.011 to 0.118 mg/L in sweat and from 4.7 to 8.5 mg/L in blood. Conclusion: Our results serve as proof-of-concept that vancomycin is detectable in eccrine sweat and may serve as a surrogate marker for antibiotic tissue penetration. A targeted vancomycin treatment is crucial in patients with repetitive need for antibiotics and a variable antibiotic distribution such as in peripheral artery disease to optimize treatment effectiveness. If combined with on-skin smartphone-based biosensors and smartphone applications, the detection of antibiotic concentrations in sweat might enable a first digital, on-spot, lab-independent and non-invasive therapeutic drug monitoring in skin and soft tissue infections.
Digit Biomark 2021;5:24–28

中文翻译：

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汗液中万古霉素的检测：抗生素组织渗透的下一代数字替代标记：初步研究


背景：确保感染时足够的抗生素组织浓度，尤其是皮肤和软组织感染，对于有效治疗和治愈至关重要。尽管存在全球性问题，但仍缺少可靠的 AB 监测测试。抗生素治疗不充分会导致抗生素耐药性和毒副作用的产生。之前接受过静脉注射相应抗生素治疗的患者的汗液中已经检测到了β-内酰胺类抗生素。随着基于智能手机的生物传感器的出现，可以在需要时分析汗液，下一代分子数字生物标志物将越来越多地用于非侵入性药物治疗监测。目的：在这里，我们调查了接受静脉注射万古霉素治疗的住院患者的汗液样本中是否可以检测到糖肽抗生素万古霉素。方法：使用 Macroduct Sweat Collector® 收集小汗腺汗液样本。沿着每个汗液样本，还采集了血液样本。通过超高压液相色谱-串联四极杆质谱联用串联质谱进行生物流体分析。结果：共纳入5例患者。结果表明，5 个汗液样本中有 5 个检测到了万古霉素。具体来说，汗液中的万古霉素浓度为 0.011 至 0.118 mg/L，血液中的万古霉素浓度为 4.7 至 8.5 mg/L。结论：我们的结果证明万古霉素可在小汗腺汗液中检测到，并可作为抗生素组织渗透的替代标记物。 对于重复需要抗生素和抗生素分布可变的患者（例如外周动脉疾病），有针对性的万古霉素治疗至关重要，以优化治疗效果。如果与基于智能手机的皮肤生物传感器和智能手机应用相结合，汗液中抗生素浓度的检测可能会在皮肤和软组织感染中实现第一个数字化、现场、独立于实验室和非侵入性的治疗药物监测。

数字生物标志 2021；5:24–28