Effect of dialysate fluids on phagocytosis and killing by normal neutrophils

Inadequate host defenses may partly explain the problem of recurrent peritonitis in patients on continuous ambulatory peritoneal dialysis. It has been suggested that these defenses may be adversely affected by the fluids used for dialysis, and so we examined the effects of unused, effluent, and infected peritoneal dialysis fluids on phagocytosis and killing by normal neutrophils. We used a clinical isolate of Staphylococcus epidermidis as the test organism, as this organism is the most commonly cultured in continuous ambulatory peritoneal dialysis peritonitis; we also used a fungal species, Candida guilliermondii. There was no phagocytosis of either organism in unused dialysate because of lack of opsonins and low pH. Phagocytosis in effluent dialysate did not occur because of inadequate opsonin levels and was variable in infected effluents, depending on quantities of immunoglobulins present. Intracellular killing of both test organisms was normal in unused dialysate in the presence of 5% normal serum, but was reduced in effluent and infected dialysates because of factors inhibiting killing by neutrophils. These factors adversely affected the killing of S. epidermidis more than that of C. guilliermondii. These results may explain why peritonitis recurs, particularly peritonitis due to S. epidermidis, because organisms could be sequestered within the neutrophils and thus be protected from antibiotic action. Reinfection of the peritoneal cavity would then take place following neutrophil breakdown, causing a clinical relapse.