{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:08:37Z","timestamp":1787018917401,"version":"build-2736575974"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perit Dial Int"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peritoneal dialysis (PD)\u2014associated peritonitis remains a leading cause of hospitalization, technique failure, and transfer to in-center hemodialysis, with touch contamination during connections accounting for many episodes. Although shrouded connectors and \u201cflush before fill\u201d mechanisms reduce contamination risk, most automated peritoneal dialysis (APD) systems incorporate recessed fluid paths on only one side of the tubing\u2013bag interface, potentially allowing bacterial transfer. We evaluated whether bilateral shrouded connectors with recessed fluid paths reduce bacterial contamination during simulated APD therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In vitro microbiological testing was performed using three APD systems: Vantive\/Baxter Claria\u2122 (System A), Fresenius Liberty\u2122 (System C), and Simergent Archimedes\u2122 (System B). Connectors were deliberately contaminated with\n                      <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                      to simulate touch contamination, followed by a simulated APD treatment. Bacterial growth was quantified from pre-therapy flush fluid and the first patient fill (\u201cmock peritoneum\u201d). Agar imprinting was used to assess bacterial distribution relative to connector geometry.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Bacterial growth adjacent to the fluid path was observed with contaminated System A connectors but not with System B or System C, where growth was confined to the shroud. Quantitative cultures demonstrated markedly higher bacterial transfer with System A compared with System B and System C across both flush and mock peritoneal samples. Systems B and C employing bilateral shrouded, recessed connectors showed bacterial counts several orders of magnitude lower. All aseptic controls were sterile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bilateral shrouded connectors with recessed fluid paths substantially reduce transfer of touch contaminants during simulated APD therapy. This design may mitigate a major mechanism of PD-related peritonitis, warranting clinical evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08968608261461078","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T13:49:27Z","timestamp":1782222567000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["An in vitro comparison of bacterial touch contamination prevention between a novel APD cycler connector and existing APD connectors"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7948-9547","authenticated-orcid":false,"given":"James A","family":"Sloand","sequence":"first","affiliation":[{"name":"The George Washington University School of Medicine & Health Sciences"},{"name":"Simergent LLC, Oklahoma City, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy P","family":"Burton","sequence":"additional","affiliation":[{"name":"St. Joseph's Health Care, Lawson Research Institute, London, Ontario, Canada"},{"name":"Department of Microbiology and Immunology and the Department of Surgery (Division of Urology), Faculty at Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris I","family":"Munday","sequence":"additional","affiliation":[{"name":"St. Joseph's Health Care, Lawson Research Institute, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arsh K","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Medicine (Division of Nephrology) and the Department of Epidemiology &amp; Biostatistics, Faculty at Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama El","family":"Shamy","sequence":"additional","affiliation":[{"name":"University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"Pendergraft","sequence":"additional","affiliation":[{"name":"Simergent LLC, Oklahoma City, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve J","family":"Lindo","sequence":"additional","affiliation":[{"name":"Simergent LLC, Oklahoma City, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2147\/IJNRD.S123618"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3747\/pdi.2016.00078"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5001916"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2016010112"},{"key":"e_1_3_2_6_2","first-page":"1","article-title":"Time trends and causes of infection-related mortality among patients starting dialysis in Finland: a nationwide cohort study","volume":"7","author":"Kinnunen S","year":"2015","unstructured":"Kinnunen S, Helanter\u00e4 I, Juutilainen A, et al. 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