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Bactericidal Properties of Acidified (pH 2.0), Concen‐trated (27%) NaCl (ACS), a Potentially Useful Agent for Locking Hemodialysis Catheters
Author(s) -
Moore HL,
Twardowski ZJ.
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.00123.x
Subject(s) - staphylococcus epidermidis , saline , staphylococcus aureus , sodium hypochlorite , medicine , microbiology and biotechnology , chromatography , chemistry , bacteria , anesthesia , organic chemistry , biology , genetics
Between dialyses, the catheter lumens are commonly locked with heparin (H), which does not prevent bacterial growth. Trisodium citrate (TSC) has been used as a locking agent because of its anticoagulant effects and suggested bactericidal properties. The purpose of this study was to evaluate the bactericidal properties of ACS as a potential locking agent in the air‐bubble locking method (Twardowski ZJ et al. Air‐bubble method of locking central‐vein catheter: A pilot study. Hemodial Int. Abstracts, 2003; 7: this issue). ACS does not induce formation of resistant strains, and is harmless if a small amount (0.5–1.5 ml) is incidentally injected. Other bactericidal agents, such as Chlorhexidine (Ch), povidone iodine (PI), TSC, and sodium hypochlorite (SH) are harmful if incidentally injected. Bactericidal properties of ACS were compared to 27% NaCl, normal saline (NS) bacteriostatic NS (BNS), 1% SH, 0.057% SH, 46% TSC, 23% TSC, H 5000 units/ml, H 10,000 units/ml diluted with BNS to 5000 units/ml, 4% Ch, and 10% PI. Effects on 8 organisms were studied: S. aureus , penicillin and methicillin resistant S. aureus, S. epidermidis, K. pneumoniae, P. aeruginosa, E. coli , and C. albicans . The organisms were prepared following the manufacturers’ protocols with a final concentration of 10 7 –10 8 cfu/ml for bacteria and 10 4 –10 5 cfu/ml for yeast. Following standard microbiological technique, a 10‐μl loop of preparation was added to 1 ml of each of the solutions. A sample of each solution was removed and plated at 0, 1, 3, 6, 24, 48, 72, and 96 hrs. All plates were subsequently counted 24 hrs after plating. Eight to eleven samples of each organism were tested on each solution. ACS, PI, 0.057% SH, and Ch, killed bacteria in 90%, 69%, 68%, and 61%, of samples immediately (at 0 hr); 100% of samples from these solutions showed no growth at 24 hrs. Only 1–5% of samples from other solutions showed no growth at 0 hr. All samples from BNS and 1% SH showed no growth at 24 hrs; samples taken from other solutions showed growth in 17–68% samples at 24 hrs. The percent of sterile samples taken from the latter solutions gradually increased with time, probably due to lack of nutrients. We conclude that ACS may be useful as a bactericidal agent for the air‐bubble method of central‐vein catheter locking. Bactericidal properties of 46% and 23% TSC were not confirmed in this study.