Huang Louis L, Ramas Ellen, Prasad Priti, Catania Jenny, Meade Pauline, Butler Eamonn, McMahon Lawrence P
Department of Renal Medicine, Eastern Health, Box Hill, Victoria, Australia
Department of Renal Medicine, Eastern Health, Box Hill, Victoria, Australia.
Perit Dial Int. 2018 Jan-Feb;38(1):65-67. doi: 10.3747/pdi.2017.00106.
There is a paucity of data on the sterility of peritoneal dialysis fluid (PDF) after drug admixture. International Society for Peritoneal Dialysis (ISPD) guidelines suggest using sterile technique when admixing antibiotics; however, the degree of sterility remains unclear. This issue is most pertinent when preparing take-home PDF for outpatient treatment of peritonitis. This study compares the sterility of PDF admixed with antibiotics using a non-touch aseptic technique (NTAT) versus sterile technique.Groups of 8 PDF mixtures (1.5% Dianeal or Icodextrin [Baxter International Inc., Spring Grove, IL, USA]) were admixed with 1 g/L ceftazidime and vancomycin, or 20 mL saline, either by a pharmacist using sterile technique in a sterile suite, or a nurse in a clinical room using NTAT. Dianeal inoculated with 1 × 10 colony-forming units (CFU)/L of coagulase-negative (CNS), with and without antibiotics, served as positive controls. Admixed PDFs were left at room temperature for 72 hours, then cultured using the BacT/ALERT system. A positive culture by day 5 constituted a contamination. Differences in proportion of contamination between groups were assessed using the Chi-squared test.Eighty PDF bags underwent microbiological testing. Sterility was maintained in all bags, independent of technique (NTAT versus sterile technique), type of PDF (Dianeal versus Icodextrin), or whether antibiotics were admixed. Of the positive controls, CNS-inoculated PDFs without antibiotics were all culture positive; however, when inoculated into antibiotic-admixed PDFs, only remained culture-positive ( < 0.0001).In conclusion, PDF sterility can be maintained using NTAT for up to 3 days at room temperature. Currently, there is insufficient evidence to adopt sterile technique in sterile suites when admixing take-home PDF.
关于药物混合后腹膜透析液（PDF）的无菌性数据匮乏。国际腹膜透析学会（ISPD）指南建议在混合抗生素时使用无菌技术；然而，无菌程度仍不明确。在为门诊腹膜炎患者准备带回家的PDF时，这个问题最为关键。本研究比较了使用非接触无菌技术（NTAT）与无菌技术混合抗生素后的PDF无菌性。将8组PDF混合物（1.5%的百特腹透液或艾考糊精[美国伊利诺伊州斯普林格罗夫市百特国际公司]）与1 g/L的头孢他啶和万古霉素或20 mL生理盐水混合，要么由药剂师在无菌操作间使用无菌技术进行混合，要么由护士在临床病房使用NTAT进行混合。接种了1×10菌落形成单位（CFU）/L凝固酶阴性（CNS）的百特腹透液，无论有无抗生素，作为阳性对照。混合后的PDF在室温下放置72小时，然后使用BacT/ALERT系统进行培养。第5天培养呈阳性即视为污染。使用卡方检验评估各组污染比例的差异。八十袋PDF接受了微生物检测。所有袋子均保持无菌，与技术（NTAT与无菌技术）、PDF类型（百特腹透液与艾考糊精）或是否混合抗生素无关。在阳性对照中，未添加抗生素的接种CNS的PDF均培养呈阳性；然而，接种到添加抗生素的PDF中时，只有 仍培养呈阳性（<0.0001）。总之，使用NTAT在室温下可使PDF无菌性维持长达3天。目前，在混合带回家的PDF时，没有足够的证据支持在无菌操作间采用无菌技术。
