title: Evaluation of an antimicrobial-impregnated continuous ambulatory peritoneal dialysis catheter for infection control in rats.
abstract: Infection is the most serious complication arising in long-term continuous ambulatory peritoneal dialysis (CAPD), specifically peritonitis and exit-site infection. The initial weeks after implantation is the crucial period during which bacterial colonization of the catheter results in maximal morbidity, with Staphylococcus aureus being the most virulent organism. We developed an antimicrobial-impregnated CAPD catheter by impregnating the cuff and tubing with chlorhexidine, silver sulfadiazine, and triclosan in a polymer matrix. The antimicrobial spectrum and duration were shown by measuring zones of inhibition to various bacteria and fungi over the course of 5 to 10 days. Activity also was assessed subsequent to soaking in trypticase soy broth containing 20% bovine serum over the course of 1, 3, and 7 days. Significant antimicrobial activity was shown against all organisms tested for, with particular efficacy against gram-positive bacteria. Catheters were implanted in rats followed by inoculation of the exit site with S aureus. Seven days postimplantation, 0% of the impregnated catheters were colonized intraperitoneally compared with 100% of the control catheters. Similarly, 12.5% of the impregnated catheters were colonized at the exit site, whereas 100% of the controls were colonized. Histologic analysis showed that this combination and concentration of antimicrobials did not retard healing or cause increased inflammation compared with control catheters after 3, 10, and 24 days postimplantation in noninoculated rats.
authors.affiliation: Columbia University College of Physicians & Surgeons, New York, NY 10032-3702, USA.
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Kim
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Lester
authors.initials: L
authors.lastname: Sampath
authors.forename: Karen
authors.initials: K
authors.lastname: Sokol
authors.forename: Shanta
authors.initials: S
authors.lastname: Modak
mesh_terms: D000818:Animals; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D002176:Candida albicans / Q000187:drug effects / Q000254:growth & development; D002408:Catheters, Indwelling / Q000009:adverse effects; D002710:Chlorhexidine / Q000494:pharmacology; D004926:Escherichia coli / Q000187:drug effects / Q000254:growth & development; D005260:Female; D008826:Microbial Sensitivity Tests; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000295:instrumentation*; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012837:Silver Sulfadiazine / Q000494:pharmacology; D013210:Staphylococcus / Q000187:drug effects / Q000254:growth & development; D013211:Staphylococcus aureus / Q000187:drug effects / Q000254:growth & development; D014260:Triclosan / Q000494:pharmacology
chemical_list: D000891:Anti-Infective Agents, Local; D014260:Triclosan; D002710:Chlorhexidine; D012837:Silver Sulfadiazine