Chlorhexidine for routine PD catheter exit-site care

Balafa, Olga; Zarzoulas, Fotis; Ikonomou, Margarita; Xiromeriti, Sofia; Konstantinos, Siamopoulos

doi:10.1007/s11255-016-1370-4

Cited by 3 publications

(8 citation statements)

References 12 publications

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“…Findlay et al [18] showed the significant effectiveness of mupirocin on ESI. In contrast, the studies by Olga et al [16] and Wong et al [34] exhibited no significance in preventing ESI. In the study by Findlay et al [18], the prevalence of diabetes was significantly lower in mupirocin group despite random allocation, which might have biased towards less ESI in mupirocin group.…”

Section: Discussionmentioning

confidence: 81%

“…Our meta-analysis included only randomized studies that used only adult cases as subjects, and we used 6 RCTs after excluding the application of antibiotic ointment to the nasal cavity. Three studies compared the mupirocin ointment group and the control group [16,18,34], and only 3 studies compared the mupirocin and gentamicin ointment groups [9,17,19]. Among the RCTs we used, only 1 overlapped with the report by Xu et al [13].…”

Section: Discussionmentioning

confidence: 99%

“…Fifty-one references were cited in these SRs. Among them, 4 studies met our criteria [9,16,19,34]. Further database search for more recent articles identified 1 CPG [7] and 1 RCT [17] meeting our inclusion criteria.…”

Section: Study Selectionmentioning

confidence: 99%

“…Among the 6 studies, 3 studies compared the application of mupirocin ointment with no antibiotic ointment on the exit site [16,18,34], and the other 3 studies compared the application of mupirocin ointment with gentamicin ointment on the exit site [9,17,19] (Table 1). An erratum [35] for authors' names was published for the study by Olga et al [16]. The study has been cited in other articles as Olga et al and to avoid confusion in this study, the study was cited as Olga 2016 rather than Balafa 2017.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…The ISPD guidelines' recommendation, however, were based on the previous metaanalyses including the studies that targeted patients applying nasal mupirocin ointment or nasal carriers of Staphylococcus or retrospective studies [13] that should be meta-analyzed and presented separately from randomized controlled trials (RCTs) [15]. Moreover, several RCTs were published since the publication of metaanalyses [16][17][18]. Therefore, these results might lead to misleading interpretation on the establishment of the guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Topical application of mupirocin to exit sites in patients on peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials

et al. 2020

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Background The International Society for Peritoneal Dialysis guidelines recommends the topical application of antibiotics on the exit site for the prevention of peritoneal dialysis (PD)-related infections. However, the recommendation is based on meta-analyses on applying nasal mupirocin ointment or observational or retrospective studies. Here, we evaluated the efficacy of topical application of mupirocin on the exit site for the prevention of PD-related infections. Methods We searched the databases, MEDLINE and CENTRAL, documenting the topical application of antibiotics on the exit site in PD patients in April 2017. We included only randomized controlled trials (RCTs) with adult patients wherein the effects of mupirocin were examined. Exit site infection (ESI), peritonitis, and technical failure were assessed as the main outcomes. Results Overall, six RCTs were included in this study. It was uncertain whether the application of mupirocin ointment prevents ESI (rate ratio (RR), 0.36; 95% CI, 0.13–1.05), peritonitis (RR 0.78, 95% CI 0.50–1.21), and technical failure (RR, 1.35; 95% CI, 0.25–7.21). Moreover, a comparison between mupirocin and gentamicin showed no difference in the incidence of ESI (RR, 1.14; 95% CI, 0.27–4.81), peritonitis (RR, 0.85; 95% CI, 0.32–2.26), and technical failure (RR, 0.58; 95% CI, 0.28–1.20). Conclusions It remains unclear whether topical application of mupirocin on the exit site has any significant effects on PD-related infection or technical failure. Large-scale RCTs with high methodological quality are required to confirm the efficacy of topical application of antibiotics on the exit site. Trial registration UMINR000039267

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Topical application of mupirocin to exit sites in patients on peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials

et al. 2020

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Catheter-related infections in peritoneal dialysis: comparison of a single center results and the literature data

et al. 2019

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Comparative Effectiveness of Local Application of Chlorhexidine Gluconate, Mupirocin Ointment, and Normal Saline for the Prevention of Peritoneal Dialysis-related Infections (COSMO-PD Trial): a multicenter randomized, double-blind, controlled protocol

Nochaiwong

Ruengorn

Noppakun

et al. 2019

Trials

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BackgroundCurrent international guidelines recommend the use of a daily topical exit-site antimicrobial to prevent peritoneal dialysis (PD)-related infections. Although nonantibiotic-based therapies are appealing because they may limit antimicrobial resistance, no controlled trials have been conducted to compare topical antimicrobial agents with usual exit-site care for the prevention of PD-related infections among the Thai PD population. We propose a controlled three-arm trial to examine the efficacy and safety of a daily chlorhexidine gluconate-impregnated patch versus mupirocin ointment versus usual exit-site care with normal saline for the prevention of PD-related infections.Methods/DesignsThis study is a randomized, double-blind, multicenter, active-controlled, clinical trial. Adult patients aged 18 years or older who have end-stage kidney disease and are undergoing PD will be enrolled at three PD Centers in Thailand. A total of 354 PD patients will be randomly assigned to either the 2% chlorhexidine gluconate-impregnated patch, mupirocin ointment, or usual exit-site care with normal saline dressing according to a computer-generated random allocation sequence. Participants will be followed until discontinuation of PD or completion of 24 months. The primary study outcomes are time to first PD-related infection (exit-site/tunnel infection or peritonitis) event and the overall difference in PD-related infection rates between study arms. Secondary study outcomes will include (i) the rate of infection-related catheter removal and PD technique failure, (ii) rate of nasal and exit-site Staphylococcus aureus colonization, (iii) healthcare costs, and (iv) skin reactions and adverse events. We plan to conduct a cost-utility analysis alongside the trial from the perspectives of patients and society. A Markov simulation model will be used to estimate the total cost and health outcome in terms of quality-adjusted life years (QALYs) over a 20-year time horizon. An incremental cost-effectiveness ratio in Thai Baht and U.S. dollars per QALYs gained will be illustrated. A series of probabilistic sensitivity analyses will be conducted to assess the robustness of the cost-utility analysis findings.DiscussionThe results from this study will provide new clinical and cost-effectiveness evidence to support the best strategy for the prevention of PD-related infections among the Thai PD population.Trial registrationClinicalTrials.gov, NCT02547103. Registered on September 11, 2015.

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Chlorhexidine for routine PD catheter exit-site care

Abstract: Mupirocin is not superior in preventing infections comparing with chlorhexidine in this cohort of patients.

Cited by 3 publications

References 12 publications

Topical application of mupirocin to exit sites in patients on peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials

Topical application of mupirocin to exit sites in patients on peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials

Catheter-related infections in peritoneal dialysis: comparison of a single center results and the literature data

Comparative Effectiveness of Local Application of Chlorhexidine Gluconate, Mupirocin Ointment, and Normal Saline for the Prevention of Peritoneal Dialysis-related Infections (COSMO-PD Trial): a multicenter randomized, double-blind, controlled protocol

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