scholarly journals Design and proof-of-concept evaluation of a touchless connector system for preventing peritoneal dialysis-associated peritonitis.

2021 ◽  
Author(s):  
Ibrahim O. Yekinni ◽  
Thomas Viker ◽  
Ryan Hunter ◽  
Aaron Tucker ◽  
Sarah Elfering ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Standard Of Care ◽  
Luria Bertani ◽  
Worst Case ◽  
Colony Forming Units ◽  
Concept Evaluation ◽  
Peritoneal Dialysis Fluid ◽  
Test Organisms ◽  
Further Development

In this paper, we describe the design of a touchless peritoneal dialysis connector system and how we evaluated its potential for preventing peritoneal dialysis-associated peritonitis, in comparison to the standard of care. The unique feature of this system is an enclosure within which patients can connect and disconnect for therapy, protecting their peritoneal catheters from touch or aerosols. We simulated a worst-case contamination scenario by spraying 40mL of a standardized inoculum [1x107 colony-forming units (CFU) per milliliter] of test organisms, Staphylococcus epidermidis ATCC1228 and Pseudomonas aeruginosa ATCC39327, while test participants made mock connections for therapy. We then compared the incidence of fluid path contamination by test organisms in the touchless connector system and the standard of care. 4 participants were recruited to perform a total of 56 tests, divided in a 1:1 ratio between both systems. Peritoneal dialysis fluid sample from each test was collected and maintained at body temperature (37 C) for 16 hours before being plated on Luria Bertani agar, Mannitol Salts Agar and Pseudomonas isolation agar for enumeration. No contamination was observed in the test samples from the touchless connector system, compared to 65%, 75% and 70% incidence contamination for the standard of care on Luria Bertani agar, Mannitol Salts Agar and Pseudomonas isolation agar respectively. In conclusion, the results show that the touchless connector system can prevent fluid path contamination even in heavy bacterial exposures and may help reduce peritoneal dialysis-associated peritonitis risks from inadvertent contamination with further development.

Growth of Bacterial Clinical Isolates in Continuous Ambulatory Peritoneal Dialysis Fluid

1983 ◽  
Vol 3 (3) ◽  
pp. 144-145 ◽  
Author(s):  
Dayl J. Flournoy ◽  
Fred A. Perryman ◽  
Syed M.H. Qadri
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Chemical Constituent ◽  
Pseudomonas Sp ◽  
Bacterial Isolates ◽  
Proteus Vulgaris ◽  
Dialysis Fluid ◽  
Colony Forming Units ◽  
Peritoneal Dialysis Fluid ◽  
Group D

Clinical bacterial isolates (105 colony forming units/mi) were inoculated into sterile unused and used continuous ambulatory peritoneal dialysis (CAPD) fluid, incubated for 24 hours at 3SOC and observed for growth as evidenced by turbidity. The CAPD fluids also were tested for selected chemical constituent concentrations. The main differences in sterile unused and used fluids were: pH, 5.25 (unused) vs 7.60–8.62 (used); glucose, 1350–3680 vs 407–1227 mg/dl; potassium, 0 vs 2.0–4.2 mEq/l and phosphorous, 0 and 2.5–5.5 mg/dl respectively. When isolates of Candido albicans (10 strains), Enterobacter sp. (2), Escherichia coli (2), Group D Enterococci (2), Klebsiella pneumoniae (2), Proteus vulgaris (2), Pseudomonas aeruginosa (30), Pseudomonas sp. (2), Serratia marcescens (2), Staphylococcus aureus (2), S. epidermidis (2) and alphahemolytic streptococci (10) were tested against the fluids, none of the isolates grew in unused fluid but all grew in used fluid, which had been in the peritoneal cavity for as little as one and one-halfhours. Although the organisms did not grow in unused fluid, they were still viable at their original concentrations as deterrnined by quantitative subcultures.

Establishing an Experimental Infection Model for Peritoneal Dialysis: Effect of Inoculum and Volume

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 79-81 ◽  
Author(s):  
Wim Calame ◽  
Charles Afram ◽  
Nico Blijleven ◽  
Roeland J.B.M. Hendrickx ◽  
Ferry Namavar ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Experimental Infection ◽  
Staphylococcus Epidermidis ◽  
Infection Model ◽  
Bacterial Number ◽  
Colony Forming Units ◽  
Number Of Bacteria ◽  
Experimental Infection Model

The effect of the number of bacteria and the volume of the inoculum was studied in an experimental infection model to establish a peritoneal dialysis model in the rat. Staphylococcus aureus was used in all experiments, and Staphylococcus epidermidis only in the volume experiments. A bacterial number between 108 and 109 colony forming units (cfu) resulted in a time-dependent decrease of bacteria collected from the peritoneal cavity. Higher concentrations resulted in the death of animals, while lower concentrations were rapidly cleared. There was a positive correlation between the volume in which 3 x 108 cfu were dissolved and the number of bacteria isolated from the peritoneal cavity 24 hours after infection. The results of this study led to an experimental dialysis model using 10 mL of dialysis fluid and 0.5 mL of a suspension containing 3 x 108 cfu of Staphylococcus aureus.

scholarly journals In VitroMicrobiology Studies on a New Peritoneal Dialysis Connector

2012 ◽  
Vol 32 (5) ◽  
pp. 552-557
Author(s):  
Giovanni Di Bonaventura ◽  
Paolo Cerasoli ◽  
Arianna Pompilio ◽  
Fabio Arrizza ◽  
Lorenzo Di Liberato ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Bacterial Infection ◽  
Flow Control ◽  
Clinical Setting ◽  
Staphylococcus Epidermidis ◽  
Colony Forming Units ◽  
Airborne Contamination

ObjectiveWe evaluated the ability of a recently developed peritoneal dialysis (PD) connector to prevent the risk of bacterial transfer to the fluid path after simulated touch and airborne contamination.MethodsStaphylococcus epidermidis ATCC1228 and Pseudomonas aeruginosa ATCC27853 strains were used. For touch contamination, 2 μL of a standardized inoculum [1x108colony-forming units (CFU) per milliliter] were deposited on top of the pin closing the fluid path of the patient connector. For airborne contamination, the patient connector was exposed for 15 seconds to a nebulized standardized inoculum. To simulate the patient peritoneum and effluent, the patient connector was pre-attached to a 2-L bag of sterile PD solution. After contamination, the patient connector was attached to the transfer set, the pin was captured, flow control was turned to simulate “patient drain” into the empty bag, and then “patient fill” using the bag pre-attached to the connector. Finally, a new pin was recaptured. The PD solution collected in the bag pre-attached to the connector was run through a 0.20-μm filter for colony counts.ResultsNo infected connector transferred bacteria to the fluid path, regardless of the challenge procedure or the strain used.ConclusionsOur results show that the new PD connector may fully obviate the risk of bacterial infection, even in the presence of heavy contamination. Further studies are in progress to test our PD connector in a clinical setting.

Scanning Electron Microscopy of Staphylococcus Epidermidis Adherence to Continuous Ambulatory Peritoneal Dialysis Catheters

1985 ◽  
Vol 43 ◽  
pp. 520-521
Author(s):  
William J. Lamoreaux ◽  
David L. Smalley ◽  
Larry M. Baddour ◽  
Alfred P. Kraus
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Sterile Saline ◽  
Intravascular Devices ◽  
Capd Patient ◽  
Scanning Electron

Infections associated with the use of intravascular devices have been documented and have been reported to be related to duration of catheter usage. Recently, Eaton et al. reported that Staphylococcus epidermidis may attach to silastic catheters used in continuous ambulatory peritoneal dialysis (CAPD) treatment. The following study presents findings using scanning electron microscopy (SEM) of S. epidermidis adherence to silastic catheters in an in vitro model. In addition, sections of polyvinyl chloride (PVC) dialysis bags were also evaluated by SEM.The S. epidermidis strain RP62A which had been obtained in a previous outbreak of coagulase-negative staphylococcal sepsis at local hospitals was used in these experiments. The strain produced surface slime on exposure to glucose, whereas a nonadherent variant RP62A-NA, which was also used in these studies, failed to produce slime. Strains were grown overnight on blood agar plates at 37°C, harvested from the surface and resuspended in sterile saline (0.85%), centrifuged (3,000 rpm for 10 minutes) and then washed twice in 0.1 M phosphate-buffered saline at pH 7.0. Organisms were resuspended at a concentration of ca. 106 CFU/ml in: a) sterile unused dianeal at 4.25% dextrose, b) sterile unused dianeal at 1.5% dextrose, c) sterile used dialysate previously containing 4.25% dextrose taken from a CAPD patient, and d) sterile used dialysate previously containing 1.5% dextrose taken from a CAPD patient.

Time to Positivity of Bacteria Cultures in Peritoneal Dialysis Fluid: Evaluation of Different Laboratory Techniques

2017 ◽  
Vol 37 (3) ◽  
pp. 342-344
Author(s):  
Roberta M. Katzap ◽  
Vany Elisa Pagnussatti ◽  
Ana Elizabeth Figueiredo ◽  
Julia Gabriela Motta ◽  
Domingos O. d'Avila ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Fluid ◽  
Antibiotic Sensitivity ◽  
Positive Culture ◽  
Cross Sectional Study ◽  
Essential Elements ◽  
Coagulase Negative Staphylococcus ◽  
Cross Sectional ◽  
Peritoneal Dialysis Fluid

Patients with chronic kidney disease on peritoneal dialysis (PD) are susceptible to infections, with peritonitis being the primary cause of dropout. Peritoneal fluid culture is one of the essential elements for proper diagnosis and peritonitis treatment. The aim of this study was to compare the time required to obtain a positive culture using different laboratory methods. An in vitro cross-sectional study was conducted comparing different techniques for preparation and culture of bacteria in peritoneal fluid. The research was carried out with 21 sterile dialysis bags and 21 PD bags containing peritoneal fluid drained from patients without peritonitis. Fluids from the 42 PD bags were contaminated by injecting a coagulase-negative Staphylococcus suspension and then prepared for culture using 4 distinct techniques: A - direct culture; B - post-centrifugation culture; C - direct culture after 4 h sedimentation; and D - culture after 4 h sedimentation and centrifugation. This was followed by seeding. In the 21 contaminated sterile bags, mean times to obtain a positive culture with techniques D (19.6 h ± 2.6) and C (19.1 h ± 2.3) were longer than with technique A (15.8 h ± 3.0; p < 0.01), but not statistically different from group B (19.0 h ± 3.2). The same occurred in the 21 bags drained from patients, with mean times for techniques D (14.0 h ± 1.9) and C (14.5 h ± 1.7) being longer than technique A (12.22 h ± 1.94; p < 0.05) but not statistically different from technique B (13.2 h ± 1.3). The sedimentation and centrifugation steps seem to be unnecessary and may delay antibiotic sensitivity test results by approximately 8 hours.

scholarly journals Oral Colonization ofStaphylococcusSpecies in a Peritoneal Dialysis Population: A Possible Reservoir for PD-Related Infections?

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Liliana Simões-Silva ◽  
Susana Ferreira ◽  
Carla Santos-Araujo ◽  
Margarida Tabaio ◽  
Manuel Pestana ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Oral Cavity ◽  
Staphylococcus Epidermidis ◽  
Gene Sequencing ◽  
Systemic Diseases ◽  
Sample Collection ◽  
Starting Point ◽  
Oral Colonization ◽  
Mortality Causes ◽  
Infectious Potential

Peritoneal dialysis-related infections are important morbidity/mortality causes, being staphylococci the most prevalent agents. SinceStaphylococcus aureusnasopharynx carriage is a known risk factor for PD infections and the oral cavity is a starting point for systemic diseases development, we aimed at comparing the oral staphylococci colonization between PD patients and controls and studying the association with PD-related infections. Saliva samples were plated in Mannitol salt, and isolates were identified byDnaJgene sequencing. Staphylococci PD-related infections were recorded throughout the 4-year period following sample collection.Staphylococcuscolonization was present in >90% of the samples from both groups (a total of nine species identified). PD patients presented less diversity and less prevalence of multispeciesStaphylococcuscolonization. Although all patients presentingStaphylococcus epidermidisPD-related infections were also colonized in the oral cavity by the same agent,only 1 out of 7 patients with ESI caused byS.aureuspresentedS. aureusoral colonization. Staphylococci are highly prevalent in the oral cavity of both groups, although PD patients presented less species diversity. The association between oralStaphylococcuscarriage and PD-related infections was present forS. epidermidisbut was almost inexistent forS. aureus, so, further studies are still necessary to evaluate the infectious potential of oralStaphylococcuscarriage in PD.

scholarly journals Do We Have a Biocompatible Peritoneal Dialysis Fluid?

2012 ◽  
Vol 02 (03) ◽  
pp. 29-34
Author(s):  
Shadi Hassan ◽  
Batya Kristal ◽  
Khalid Khazim ◽  
Fadi Hassan ◽  
Dunia Hassan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Fluid ◽  
Peritoneal Dialysis Fluid

scholarly journals Peritoneal dialysis fluid inhibition of phagocyte function: effects of osmolality and glucose concentration.

1993 ◽  
Vol 3 (8) ◽  
pp. 1508-1515
Author(s):  
T Liberek ◽  
N Topley ◽  
A Jörres ◽  
G A Coles ◽  
G M Gahl ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lactate Dehydrogenase ◽  
Glucose Concentration ◽  
Lactate Concentration ◽  
Mononuclear Leukocytes ◽  
Dependent Manner ◽  
Dialysis Fluid ◽  
Glucose Content ◽  
Peritoneal Dialysis Fluid ◽  
Dialysis Fluids

Solutions were formulated to examine, independently, the roles of osmolality and glucose in the reduction of viability and inhibition of phagocyte function by dextrose-containing peritoneal dialysis fluids. The exposure of neutrophils (polymorphonuclear leukocytes) to test fluids containing > or = 2.7% (wt/vol) glucose resulted in significant cytotoxicity as assessed by the release of lactate dehydrogenase above control values (7.12 +/- 2.65%). At the highest concentration of glucose (4.5%), lactate dehydrogenase release was 15.83 +/- 0.49% (P < 0.05). These effects were directly related to the presence of D-glucose in the test fluids. In contrast, phagocytosis and the release of leukotriene B4 from PMN stimulated with serum-treated zymosan were significantly inhibited in an osmolality-, but not glucose-, dependent manner. The inhibition of tumor necrosis factor alpha and interleukin-6 release from mononuclear leukocytes was inhibited by a combination of osmolality and monosaccharide concentration. Under the same conditions, PMN respiratory burst activation remained unaffected irrespective of glucose concentration or fluid osmolality. These data indicate that, in addition to the low pH of peritoneal dialysis fluid and its high lactate concentration, its glucose content (either directly or as a consequence of the resulting hyperosmolality of the fluid) inhibits cell functional parameters. These findings suggest clinically significant inhibition of host defense mechanisms because, in high-glucose dialysis fluids, osmolality does not reach physiologic values, even during extended intraperitoneal dwell periods.

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