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Sterility of antibiotic-admixed peritoneal dialysis solution over time
Ken-Soon Tan1,2,3, Robyn Rogers1, Deanna Shephard1
1Department of Kidney services, Logan hospital, Meadowbrook, QLD, Australia.
Background:
Intraperitoneal antibiotics may be required daily for up to three weeks to treat peritoneal dialysis (PD)-related peritonitis. In some jurisdictions, antibiotic-admixed PD solutions are required to be used within 24 h due to concerns regarding microbial contamination and growth. This requires patients to attend the PD unit daily or alternatively for staff to perform home delivery with associated transport, staffing and cost implications.
Objective:
The aim of this study was to determine if significant microbial growth occurs in PD solutions following their injection with antibiotic or sterile water.
Methods:
Twelve PD solution bags were admixed with cefazolin sodium 1 g, diluted in 10 mL sterile water, while a further 12 PD solution bags were admixed with 10 mL sterile water using aseptic technique (AT) under supervision. All bags were stored at room temperature. Three bags from each experimental group were sampled for microbiologic culture at 0-, 24-, 48- and 72-h intervals.
Results:
One sterile water admixed bag sampled at 24 h yielded a Corynebacterium spp. after microbiologic culture. A repeat specimen from the same bag at day nine returned a negative culture result. All other sterile water and cefazolin admixed bags returned negative culture results at all time points.
Conclusions:
Antibiotic-admixed PD solutions prepared using AT and stored at room temperature remained sterile for up to 72 h. This suggests that patients can be safely issued with a supply of antibiotic-admixed PD bags for up to three days at a time.
Insights
Antibiotic-admixed peritoneal dialysis (PD) solutions remain sterile for up to 72 hours when prepared using aseptic technique and stored at room temperature. This finding supports extended storage, potentially reducing daily clinic visits for patients undergoing PD treatment.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritoneal dialysis (PD)-related peritonitis often requires daily intraperitoneal antibiotics for up to three weeks.
- Current regulations in some areas mandate using antibiotic-admixed PD solutions within 24 hours due to contamination concerns.
- This 24-hour limit necessitates frequent patient clinic visits or costly home delivery services.
Purpose of the Study:
- To investigate the potential for microbial growth in PD solutions after antibiotic or sterile water admixture.
- To assess the stability and sterility of antibiotic-admixed PD solutions over time.
Main Methods:
- Twelve PD solution bags were admixed with cefazolin sodium and 12 with sterile water using aseptic technique.
- All admixed bags were stored at room temperature.
- Microbiologic cultures were performed on samples taken at 0, 24, 48, and 72 hours.
Main Results:
- One sterile water-admixed bag showed a Corynebacterium spp. at 24 hours, but was negative by day nine.
- All other sterile water and cefazolin-admixed PD solutions remained sterile at all tested time points (0-72 hours).
Conclusions:
- Antibiotic-admixed PD solutions prepared aseptically and stored at room temperature are sterile for up to 72 hours.
- This stability allows for the safe issuance of up to three days' supply of antibiotic-admixed PD bags to patients.
- Extending the storage duration can improve patient convenience and reduce healthcare system burdens.
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