Immunology and the Evaluation of Risk Factors for Development of Spontaneous Bacterial Peritonitis

Lessons From Single Cell Organisms: Insights Into the Antimicrobial and Toxic Effects of Peritoneal Dialysate Bases

“…Although the antibacterial activity was lost after the dialysate had spent approximately 30 min in the abdominal cavity, the fresh dialysate was equally effective against bacteria whether an acetate‐ or lactate‐based solution was used. Paradoxically, the bactericidal effect occurred only against the most common organisms ( Staphylococcal species) responsible for peritonitis in peritoneal dialysis patients (4), but not against the much less common pathogen, Escherichia coli , which is well known to routinely traverse the bowel wall (5) and is the most frequent organism responsible for spontaneous bacterial peritonitis of Laennec cirrhosis (6,7). While the exact mechanism of the antibacterial effect is still debated (7–11), growing evidence suggests that the presence of salts of these organic acids in the peritoneal dialysate plays a significant role in the antimicrobial effect that dissipates as they either move through gluconeogenesis and the Cori cycle (Fig.…”