Kussmann M, Schuster L, Zeitlinger M, Pichler P, Reznicek G, Wiesholzer M, Burgmann H, Poeppl W
Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria.
Eur J Clin Microbiol Infect Dis. 2015 Nov;34(11):2257-63. doi: 10.1007/s10096-015-2477-8. Epub 2015 Sep 4.
Intraperitoneal administration of antibiotics is recommended for the treatment of peritoneal dialysis-related peritonitis. However, little data are available on a possible interference between peritoneal dialysis fluids and the activity of antimicrobial agents. Thus, the present in vitro study set out to investigate the influence of different peritoneal dialysis fluids on the antimicrobial activity of ampicillin, linezolid, and daptomycin against Enterococcus faecalis. Time-kill curves in four different peritoneal dialysis fluids were performed over 24 h with four different concentrations (1 × MIC, 4 × MIC, 8 × MIC, 30 × MIC) of each antibiotic evaluated. Cation-adjusted Mueller-Hinton broth was used as the comparator solution. All four peritoneal dialysis fluids evaluated had a bacteriostatic effect on the growth of Enterococcus faecalis. Compared to the cation-adjusted Mueller-Hinton broth comparator solution, the antimicrobial activity of all antibiotics tested was reduced. For ampicillin and linezolid, no activity was found in any peritoneal dialysis fluid, regardless of the concentration. Daptomycin demonstrated dose-dependent activity in all peritoneal dialysis fluids. Bactericidal activity was observed at the highest concentrations evaluated in Dianeal® PDG4 and Extraneal®, but not in concentrations lower than 30 × MIC and not in Nutrineal® PD4 and Physioneal® 40. The antimicrobial activity of ampicillin and linezolid is limited in peritoneal dialysis fluids in vitro. Daptomycin is highly effective in peritoneal dialysis fluids and might, thus, serve as an important treatment option in peritoneal dialysis-related peritonitis. Further studies are needed to evaluate the clinical impact of the present findings.
推荐腹腔内使用抗生素治疗腹膜透析相关腹膜炎。然而，关于腹膜透析液与抗菌药物活性之间可能存在的相互干扰的数据很少。因此，本体外研究旨在探讨不同腹膜透析液对氨苄西林、利奈唑胺和达托霉素抗粪肠球菌抗菌活性的影响。使用四种不同浓度（1×MIC、4×MIC、8×MIC、30×MIC）的每种抗生素，在四种不同的腹膜透析液中进行24小时的时间-杀菌曲线研究，并以阳离子调整的Mueller-Hinton肉汤作为对照溶液。所评估的四种腹膜透析液均对粪肠球菌的生长有抑菌作用。与阳离子调整的Mueller-Hinton肉汤对照溶液相比，所有测试抗生素的抗菌活性均降低。对于氨苄西林和利奈唑胺，无论浓度如何，在任何腹膜透析液中均未发现活性。达托霉素在所有腹膜透析液中均表现出剂量依赖性活性。在Dianeal® PDG4和Extraneal®中评估的最高浓度下观察到杀菌活性，但在低于30×MIC的浓度下以及在Nutrineal® PD4和Physioneal® 40中未观察到。氨苄西林和利奈唑胺在体外腹膜透析液中的抗菌活性有限。达托霉素在腹膜透析液中非常有效，因此可能是腹膜透析相关腹膜炎的重要治疗选择。需要进一步研究以评估本研究结果的临床影响。
