Potential clinical value of catheters impregnated with antimicrobials for the prevention of infections associated with peritoneal dialysis

• Published in: Expert review of medical devices Vol. 20; no. 6; pp. 459 - 466
• Main Authors: Dukka, Hari, Taal, Maarten W., Bayston, Roger
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03.06.2023
• Subjects: Anti-Infective Agents - therapeutic use; Antimicrobials; catheter; Catheterization - methods; Catheters, Indwelling - adverse effects; Humans; impregnation; peritoneal dialysis; Peritoneal Dialysis - adverse effects; peritonitis; Peritonitis - etiology; Peritonitis - prevention & control; catheter; peritoneal dialysis; Antimicrobials; peritonitis; impregnation
• ISSN: 1743-4440; 1745-2422
• DOI: 10.1080/17434440.2023.2205587

Peritoneal dialysis (PD) is a type of treatment for kidney failure. To perform PD, a silicone tube is placed in the abdomen and the other end exits through the skin. Fluid is run into the abdomen via the tube and then drained out again after 1-12 hours. This process is repeated multiple times per day. Toxins and other waste chemicals normally removed by the kidneys enter the fluid, while it is in the abdomen and are then removed from the body when the fluid is drained out. In this way, PD partially replaces kidney function. Sometimes bacteria get into the tube, and this can cause serious infections in the abdomen. At present, measures available to prevent PD tube infections include careful hygiene when handling the tube, application of antibiotic creams or ointments to the exit site or treatment with antibiotics at the time of medical procedures that may increase infection risk. Despite these measures, peritonitis (abdominal infection) is one of the most common causes of people having to stop PD and change to another form of dialysis that involves direct filtration of the blood (hemodialysis). Frequent use of antibiotics may also cause the bacteria that cause peritonitis to become resistant to antibiotics. There is, therefore, an urgent need to develop new ways to prevent PD tube infections. Tubes have been used in patients who have a particular type of brain surgery with antibiotics introduced into the material that the tube is made from, and in these patients, the risk of infection has been reduced by 60-80%. The same technology is also being tested for urine tubes that are placed in the bladder and tubes used for PD. These urine tubes and PD tubes need further testing to establish safety and effectiveness. Though our experience with them leads us to expect that they are safe, the authorities that control new drugs and devices require us to show this beyond doubt before they can be introduced into routine care. Peritoneal dialysis (PD) is a widely used dialysis modality, which offers the advantage of being a home therapy but is associated with a risk of potentially serious infections, including exit site infection, catheter tunnel infection, and peritonitis that may result in morbidity, technique failure, and increased mortality. Catheters impregnated with antimicrobials hold promise as a novel technique to reduce PD associated infections. We describe PD modalities, catheters, technique, complications, and the microbiology of associated infections, as well as standard measures to reduce the risk of infection. A novel technique for the impregnation of silicone devices with antimicrobial agents has been used to produce antimicrobial impregnated ventricular shunt catheters with proven clinical efficacy that have now been adopted as the standard of care to reduce neurosurgical infections. Using the same technology, we have developed PD and urinary catheters impregnated with sparfloxacin, triclosan, and rifampicin. Safety and tolerability have been demonstrated in urinary catheters, and a similar study is planned in PD catheters. Catheters impregnated with antimicrobials offer a simple technique to reduce PD associated infections and thereby enable more people to enjoy the advantages of PD. Clinical trials are needed to establish efficacy.