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Pseudomonas peritonitis in continuous ambulatory peritoneal dialysis: laboratory predictors of treatment failure
C F Craddock1, R Edwards, R G Finch
1Department of Microbiology, University of Nottingham.
Abstract:
Five episodes of pseudomonas peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD) which were not cured by intraperitoneal antibiotics were studied to assess causes for treatment failure. The activity of gentamicin and ceftazidime against these strains was decreased in the presence of sterile used dialysate compared with nutrient broth. Likewise, kinetic studies showed that in dialysate therapeutically used concentrations of antibiotics failed to kill the isolates over 24 h. All five pseudomonas strains were adherent to silicone rubber Tenckoff catheter segments. An in vitro model of CAPD peritonitis demonstrated that persistence of viable adherent bacteria, after exposure to therapeutic concentrations of gentamicin and ceftazidime, contributes to the failure of antibiotics to cure pseudomonas CAPD peritonitis.
Insights
Antibiotic treatment failure in continuous ambulatory peritoneal dialysis (CAPD) peritonitis is linked to Pseudomonas strains adhering to catheters. These bacteria persist despite therapeutic antibiotic concentrations in used dialysate, hindering cure.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Pseudomonas peritonitis is a serious complication of continuous ambulatory peritoneal dialysis (CAPD).
- Intraperitoneal antibiotic therapy is the standard treatment, but treatment failures occur.
- Understanding the reasons for treatment failure is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the causes of treatment failure in five cases of Pseudomonas peritonitis complicating CAPD.
- To assess the efficacy of gentamicin and ceftazidime against Pseudomonas strains in used dialysate.
- To evaluate the role of bacterial adherence to peritoneal dialysis catheters in treatment failure.
Main Methods:
- Studied five episodes of CAPD peritonitis caused by Pseudomonas.
- Assessed the activity of gentamicin and ceftazidime against clinical isolates in sterile used dialysate versus nutrient broth.
- Performed kinetic studies to evaluate antibiotic killing activity over 24 hours in dialysate.
- Examined the adherence of Pseudomonas strains to silicone rubber Tenckoff catheter segments in vitro.
- Utilized an in vitro model of CAPD peritonitis to simulate treatment conditions.
Main Results:
- Antibiotic activity of gentamicin and ceftazidime was reduced in sterile used dialysate compared to nutrient broth.
- Therapeutic concentrations of these antibiotics failed to eradicate Pseudomonas isolates in dialysate within 24 hours.
- All five Pseudomonas strains demonstrated adherence to silicone rubber Tenckoff catheter segments.
- The in vitro model showed persistence of viable, adherent bacteria after antibiotic exposure.
Conclusions:
- Reduced antibiotic activity and bacterial adherence to catheters contribute to the failure of conventional antibiotic therapy in CAPD-associated Pseudomonas peritonitis.
- Persistence of viable adherent bacteria is a key factor in antibiotic treatment failure.
- Further strategies targeting bacterial adherence and optimizing antibiotic delivery in dialysate may be necessary for effective treatment.