title: In vitro data support the investigation of vinegar as an antimicrobial agent for PD-associated Pseudomonas exit site infections.
abstract: Peritoneal dialysis exit site infections caused by Pseudomonas spp. are difficult to treat and can lead to peritonitis and/or modality failure. Effective alternative or adjunct non-antibiotic antimicrobial agents could improve treatment as well as reduce the use of antibiotics and contribute to a reduction in antibiotic selection pressure and the further development of antibiotic resistance. Vinegar is popularly promoted as a topical antimicrobial agent and has been recommended as an adjunct treatment for Pseudomonas exit site infections in PD patients. Systematic empirical data on the susceptibility of pseudomonads to vinegar are lacking. This study aimed to determine the susceptibility to vinegar of 57 isolates of Pseudomonas. The MICs and MBCs of four vinegars were determined for clinical, environmental and/or reference isolates of P. aeruginosa (n = 34), P. fluorescens (n = 11) and P. putida (n = 12) using a broth microdilution method. The MIC90and MBC90were also determined for each species. The MIC90of all four vinegars against P. aeruginosa was 2% (vol/vol). The MBC90was 8%. The MIC90s for P. fluorescens and P. putida were also 2%. The MIC90s were 4%. Dilutions of vinegar recommended for the treatment of Pseudomonas exit site infections have in vitro activity against these notoriously resistant bacteria. In light of increasing rates of antibiotic resistance and the need to reduce antibiotic selection pressure as part of good antibiotic stewardship, the efficacy of vinegar, or its active constituent acetic acid, for the treatment of Pseudomonas exit site infections should be investigated further.
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia (M503), Crawley, Australia.|Translational Renal Research Group, Harry Perkins Institute of Medical Research, Nedlands, Australia.
authors.forename: Christine F
authors.initials: CF
authors.lastname: Carson
authors.affiliation: School of Medicine, The University of Notre Dame Australia, Fremantle, Australia.
authors.forename: Oliver
authors.initials: O
authors.lastname: Ash
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia (M503), Crawley, Australia.|Translational Renal Research Group, Harry Perkins Institute of Medical Research, Nedlands, Australia.|Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Australia.
authors.forename: Aron
authors.initials: A
authors.lastname: Chakera
mesh_terms: D019342:Acetic Acid / Q000494:pharmacology*; D000890:Anti-Infective Agents / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy* / Q000382:microbiology; D011549:Pseudomonas / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000890:Anti-Infective Agents; D019342:Acetic Acid
keywords: Pseudomonas infection; catheter-associated infection; continuous ambulatory peritoneal dialysis; topical Anti-infective agent