Abstract
An in vitro model was designed for evaluating various parametersof infection and antimicrobial therapy during peritoneal dialysis (PD). The system includes a dialysis membrane sack containing commercially prepared dialysis fluid (DF) suspended in pooled human plasma, enclosed in a cylindrical flask. Ports through a rubber stopper were devised for bacterial inoculation, drug injection, and sample collection. By 6 hrs the simulated dialysis achieved pH, osmolarity, glucose, Mg++ and Ca++ values comparable to those of recovered peritoneal fluid (RPF) from patients undergoing PD. When antimicrobials (tobramycin [TOB] 8 μg/ml, piperacillin [PIP] 200 μg/ml, ceftazidime [CTZ] 100 μg/ml, or ciprofloxacin [CIP] 2 μg/ml) were added to the DF within the dialysis membrane sack, 75% of PIP and CTZ and 50% of TOB and CIP diffused into the surrounding plasma by 6 hrs. This is comparable to clinical experience with i.p. TOB or β-lactams. The bactericidal rate of the above drugs against 10 cfu/ml of P. aeruginosa was measured in DF during 6 hrs dialysis and was similar to killing kinetics in RPF from patients (no kill by PIP, <99% kill by CTZ, ≥99.9% kill by TOB and CIP). Maintaining CIP concentrations of 2 μg/ml in DF yielded ≥99.9% kill of E. coli, K. pneumoniae, S. epidermidis, and S. aureus within 2 hrs. This in vitro model may be useful in studying the kinetics of antimicrobial activity and designing studies of antimicrobial therapy for PD-related peritonitis.
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Shalit, I., Welch, D. & Marks, M. 1160 AN IN VITRO MODEL FOR ASSESSING ANTIMICROBIAL ACTIVITY DURING PERITONEAL DIALYSIS. Pediatr Res 19, 304 (1985). https://doi.org/10.1203/00006450-198504000-01190
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DOI: https://doi.org/10.1203/00006450-198504000-01190