title: An antimicrobial modified silicone peritoneal catheter with activity against both Gram-positive and Gram-negative bacteria.
abstract: Peritonitis, exit site and tunnel infections are serious complications of peritoneal dialysis (CAPD), which may lead to catheter loss, despite measures taken to reduce the infection rate. Catheters coated with antimicrobials have shown only short-term activity. We have developed a process for conferring broad-spectrum, long-duration antimicrobial activity on CAPD catheters while reducing the risk of resistance. Catheters were processed using an impregnation method. Three agents were used: rifampicin, triclosan and trimethoprim. Tests included establishing the duration of activity before test bacteria became resistant, the ability to kill 100% of attached bacteria in a predetermined time (tK100), and ability to withstand multiple high-count challenges until failure in a flow model. Antimicrobial activity continued until it was stopped at 280 days and the agents prevented the emergence of resistant strains. tK100 results showed a >99.9% reduction of attached bacteria. The flow model showed no colonization when repeatedly challenged with high loads of meticillin-resistant Staphylococcus aureus or Escherichia coli for approximately 90 days. The antimicrobial catheter material showed prolonged activity against common CAPD pathogens and promises to reduce clinical CAPD infection.
authors.affiliation: Biomaterials-Related Infection Group, Division of Orthopaedic and Accident Surgery, School of Clinical Sciences, University of Nottingham, Queens Medical Centre, Nottingham NG7 2UH, UK. roger.bayston@nottingham.ac.uk
authors.forename: Roger
authors.initials: R
authors.lastname: Bayston
authors.forename: Leanne E
authors.initials: LE
authors.lastname: Fisher
authors.forename: Klaus
authors.initials: K
authors.lastname: Weber
mesh_terms: D000818:Animals; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002408:Catheters, Indwelling; D020099:Coated Materials, Biocompatible; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000187:drug effects; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D006094:Gram-Positive Bacteria / Q000187:drug effects*; D008297:Male; D008422:Materials Testing; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D051379:Mice; D008815:Mice, Inbred Strains; D008826:Microbial Sensitivity Tests; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000295:instrumentation*; D012293:Rifampin / Q000494:pharmacology*; D012828:Silicones; D013212:Staphylococcus epidermidis / Q000187:drug effects; D014260:Triclosan / Q000494:pharmacology*; D014295:Trimethoprim / Q000494:pharmacology*
chemical_list: D020099:Coated Materials, Biocompatible; D012828:Silicones; D014260:Triclosan; D014295:Trimethoprim; D012293:Rifampin