Kussmann Manuel, Schuster Linda, Wrenger Sarah, Pichler Petra, Reznicek Gottfried, Burgmann Heinz, Poeppl Wolfgang, Zeitlinger Markus, Wiesholzer Martin
Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria.
Department of Internal Medicine I, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria.
Perit Dial Int. 2016;36(6):662-668. doi: 10.3747/pdi.2015.00161. Epub 2016 Sep 28.
♦ BACKGROUND: Peritonitis is a major problem among patients on peritoneal dialysis (PD). The influence of diverse PD fluids on the activity of frequently used antibiotics has been insufficiently investigated. Thus, the present study set out to investigate the impact of different PD fluids on the activity of cefepime, ciprofloxacin, ertapenem, meropenem, and tobramycin against Escherichia coli. ♦ METHODS: Time-kill curves in 4 different PD fluids (Dianeal PDG4, Extraneal, Nutrineal PD4 and Physioneal 40, all Baxter Healthcare Corp., Deerfield, IL, USA) were performed over 24 hours with 4 different concentrations (1 × minimum inhibitory concentration [MIC], 4 × MIC, 8 × MIC, 30 × MIC) of each antibiotic evaluated and without antibiotics as control. Cation-adjusted Mueller Hinton broth (CA-MHB) was used as comparator solution. ♦ RESULTS: In all PD fluids investigated, bacterial growth and antimicrobial activity of all antibiotics tested was significantly reduced compared with the CA-MHB comparator solution. Except at high concentrations of 30 × MIC, cefepime, ertapenem and meropenem demonstrated a strongly reduced activity in all PD fluids investigated. Ciprofloxacin and tobramycin were highly active and bactericidal in all PD fluids and demonstrated dose-dependent activity. ♦ CONCLUSION: The antimicrobial activity of cefepime, ertapenem and meropenem is limited or even nullified in certain PD fluids in vitro, whereas ciprofloxacin and tobramycin show excellent activity. The choice of PD fluids can impact the activity of antimicrobial agents and might influence microbiological outcome. Further studies are required to verify the clinical relevance of our findings.
♦ 背景：腹膜炎是腹膜透析（PD）患者面临的一个主要问题。不同腹膜透析液对常用抗生素活性的影响尚未得到充分研究。因此，本研究旨在探讨不同腹膜透析液对头孢吡肟、环丙沙星、厄他培南、美罗培南和妥布霉素抗大肠杆菌活性的影响。♦ 方法：使用4种不同浓度（1×最低抑菌浓度[MIC]、4×MIC、8×MIC、30×MIC）的每种抗生素，在4种不同的腹膜透析液（Dianeal PDG4、Extraneal、Nutrineal PD4和Physioneal 40，均由美国伊利诺伊州迪尔菲尔德的百特医疗保健公司生产）中进行24小时的时间杀菌曲线实验，并设置无抗生素组作为对照。阳离子调节的 Mueller Hinton肉汤（CA-MHB）用作对照溶液。♦ 结果：与CA-MHB对照溶液相比，在所有研究的腹膜透析液中，所有测试抗生素的细菌生长和抗菌活性均显著降低。除了在30×MIC的高浓度下，头孢吡肟、厄他培南和美罗培南在所有研究的腹膜透析液中的活性均大幅降低。环丙沙星和妥布霉素在所有腹膜透析液中均具有高活性且杀菌，并表现出剂量依赖性活性。♦ 结论：在体外，头孢吡肟、厄他培南和美罗培南在某些腹膜透析液中的抗菌活性有限甚至丧失，而环丙沙星和妥布霉素表现出优异的活性。腹膜透析液的选择会影响抗菌药物的活性，并可能影响微生物学结果。需要进一步研究来验证我们研究结果的临床相关性。
