Influence of Different Peritoneal Dialysis Fluids on theIn VitroActivity of Cefepime, Ciprofloxacin, Ertapenem, Meropenem and Tobramycin againstEscherichia Coli

Abstract

♦ 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.

Compatibility of Meropenem with Different Commercial Peritoneal Dialysis Solutions

“…This underlines the observation that the choice of a specific PDF might directly influence the activity of an antimicrobial drug as reported previously for other antibiotics (3,(10)(11)(12). In line with this, a recent study conducted by our group demonstrated that meropenem is markedly more active against E. coli in Physioneal than in Extraneal as well as in other PDFs (13). Regarding a quantitative drug concentration analysis, however, the diffusion disk method is not reliable to determine drug stability, a well-known limitation of microbiological methods (4).…”

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

“…Fluoroquinolones, including ciprofloxacin 266 and moxifloxacin, 267 have been confirmed to be compatible with PD solutions and shown to be highly active and bactericidal in PD fluids with concentration-dependent activity. 268 A small randomised controlled study supported the safety and efficacy of IP vancomycin plus oral moxifloxaicin but was not powered to be a non-inferiority trial. 234 Oral administration is an alternative and more convenient choice for susceptible organisms, as both ciprofloxacin and moxifloxacin can achieve adequate levels within the peritoneum.…”

Influence of different peritoneal dialysis fluids on the in vitro activity of fosfomycin against Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa

“…In addition, the increased activity of high dose fosfomycin (400 mg/L) in Nutrineal®, the PDF, which demonstrated the highest proliferation rate of P. aeruginosa when investigated as blank solution, supports the assumption that the bacteriostatic effect of PDFs might be the cause of reduced antimicrobial activity in PDFs in vitro [ 13 – 16 ].…”