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.
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
The authors thank Heidelinde Schranz from the Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna for the valuable suggestions, excellent technical assistance, and support in the microbiological workup.
This work was supported by the Institute of Nephrology and Hematooncology of the Karl Landsteiner Society.
Li PK-T, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A et al (2010) Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 30:393–423CrossRefPubMedGoogle Scholar
Piraino B, Bernardini J, Brown E, Figueiredo A, Johnson DW, Lye W-C et al (2011) ISPD position statement on reducing the risks of peritoneal dialysis-related infections. Perit Dial Int 31:614–630CrossRefPubMedGoogle Scholar
Salzer W (2005) Antimicrobial-resistant gram-positive bacteria in PD peritonitis and the newer antibiotics used to treat them. Perit Dial Int 25:313–319PubMedGoogle Scholar
Gorman T, Eisele G, Bailie GR (1995) Intraperitoneal antibiotics effectively treat non-dialysis-related infections. Perit Dial Int 15:283–284PubMedGoogle Scholar
Huang S-T, Chuang Y-W, Cheng C-H, Wu M-J, Chen C-H, Yu T-M et al (2011) Evolution of microbiological trends and treatment outcomes in peritoneal dialysis-related peritonitis. Clin Nephrol 75:416–425CrossRefPubMedGoogle Scholar
Cho Y, Johnson DW (2014) Peritoneal dialysis-related peritonitis: towards improving evidence, practices, and outcomes. Am J Kidney Dis 64:278–289CrossRefPubMedGoogle Scholar
Edey M, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ et al (2010) Enterococcal peritonitis in Australian peritoneal dialysis patients: predictors, treatment and outcomes in 116 cases. Nephrol Dial Transplant 25:1272–1278CrossRefPubMedGoogle Scholar
Huen SC, Hall I, Topal J, Mahnensmith RL, Brewster UC, Abu-Alfa AK (2009) Successful use of intraperitoneal daptomycin in the treatment of vancomycin-resistant enterococcus peritonitis. Am J Kidney Dis 54:538–541CrossRefPubMedGoogle Scholar
Hassoun AA, Coomer RW, Mendez-Vigo L (2009) Intraperitoneal daptomycin used to successfully treat vancomycin-resistant enterococcus peritonitis. Perit Dial Int 29:671–673PubMedGoogle Scholar
Song IJ, Seo JW, Kwon YE, Kim YL, Lim TS, Kang EW et al (2014) Successful treatment of vancomycin-resistant enterococcus peritonitis using linezolid without catheter removal in a peritoneal dialysis patient. Perit Dial Int 34:235–239PubMedCentralCrossRefPubMedGoogle Scholar
The European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2015) Routine and extended internal quality control as recommended by EUCAST. Version 5.0, valid from 2015-01-09. Home page at: http://www.eucast.org
Hermsen ED, Hovde LB, Hotchkiss JR, Rotschafer JC (2003) Increased killing of staphylococci and streptococci by daptomycin compared with cefazolin and vancomycin in an in vitro peritoneal dialysate model. Antimicrob Agents Chemother 47:3764–3767PubMedCentralCrossRefPubMedGoogle Scholar
Tobudic S, Poeppl W, Kratzer C, Vychytil A, Burgmann H (2012) Comparative in vitro antimicrobial activity of vancomycin, teicoplanin, daptomycin and ceftobiprole in four different peritoneal dialysis fluids. Eur J Clin Microbiol Infect Dis 31:1327–1334CrossRefPubMedGoogle Scholar
Shalit I, Welch DF, San Joaquin VH, Marks MI (1985) In vitro antibacterial activities of antibiotics against Pseudomonas aeruginosa in peritoneal dialysis fluid. Antimicrob Agents Chemother 27:908–911PubMedCentralCrossRefPubMedGoogle Scholar
Tobudic S, Kratzer C, Poeppl W, Vychytil A, Burgmann H (2011) Impact of various peritoneal dialysis solutions on the growth of common bacterial and yeast pathogens. Perit Dial Int 31:688–692CrossRefPubMedGoogle Scholar
Richards GK, Gagnon RF, Obst G, Kostiner GB (1993) The effect of peritoneal dialysis solutions on rifampin action against Staphylococcus epidermidis in the fluid and biofilm phases of growth. Perit Dial Int 13:S341–S344PubMedGoogle Scholar
Patel RP, Li K, Shastri M, Wanandy T, Jose MD (2015) Stability of ampicillin and amoxicillin in peritoneal dialysis solutions. Am J Health Syst Pharm 72:13–14CrossRefPubMedGoogle Scholar
Roberts DM, Fernando G, Singer RF, Kennedy KJ, Lawrence M, Talaulikar G (2011) Antibiotic stability in commercial peritoneal dialysis solutions: influence of formulation, storage and duration. Nephrol Dial Transplant 26:3344–3349CrossRefPubMedGoogle Scholar
Manley HJ, McClaran ML, Bedenbaugh A, Peloquin CA (2002) Linezolid stability in peritoneal dialysis solutions. Perit Dial Int 22:419–422PubMedGoogle Scholar
Parra MA, Campanero MA, Sádaba B, Irigoyen A, García-López L, Fernandez-Reyes MJ et al (2013) Effect of glucose concentration on the stability of daptomycin in peritoneal solutions. Perit Dial Int 33:458–461PubMedCentralCrossRefPubMedGoogle Scholar
Peyro Saint Paul L, Albessard F, Gaillard C, Debruyne D, Ryckelynck J-P, Coquerel A et al (2011) Daptomycin compatibility in peritoneal dialysis solutions. Perit Dial Int 31:492–495CrossRefPubMedGoogle Scholar
Cozens RM, Tuomanen E, Tosch W, Zak O, Suter J, Tomasz A (1986) Evaluation of the bactericidal activity of beta-lactam antibiotics on slowly growing bacteria cultured in the chemostat. Antimicrob Agents Chemother 29:797–802PubMedCentralCrossRefPubMedGoogle Scholar
Tuomanen E, Cozens R, Tosch W, Zak O, Tomasz A (1986) The rate of killing of Escherichia coli by beta-lactam antibiotics is strictly proportional to the rate of bacterial growth. J Gen Microbiol 132:1297–1304PubMedGoogle Scholar
Eagle H, Musselman AD (1948) The rate of bactericidal action of penicillin in vitro as a function of its concentration, and its paradoxically reduced activity at high concentrations against certain organisms. J Exp Med 88:99–131PubMedCentralCrossRefPubMedGoogle Scholar
Stille W, Uffelmann H (1973) Paradoxic bactericidal effect of penicillins on enterococci (Eagle effect). Dtsch Med Wochenschr 98:611–613CrossRefPubMedGoogle Scholar
Mascio CTM, Alder JD, Silverman JA (2007) Bactericidal action of daptomycin against stationary-phase and nondividing Staphylococcus aureus cells. Antimicrob Agents Chemother 51:4255–4260PubMedCentralCrossRefPubMedGoogle Scholar
Bahte SK, Bertram A, Burkhardt O, Martens-Lobenhoffer J, Goedecke V, Bode-Böger SM et al (2010) Therapeutic serum concentrations of daptomycin after intraperitoneal administration in a patient with peritoneal dialysis-associated peritonitis. J Antimicrob Chemother 65:1312–1314CrossRefPubMedGoogle Scholar