Effect of a silver device in preventing catheter-related infections in peritoneal dialysis patients: Silver ring prophylaxis at the catheter exit study

Pommer, Wolfgang; Brauner, Maximilian; Westphale, H.-J.; Brunkhorst, R.; Kramer, Ricardo Klaus; Bundschu, D; Höffken, B.; Steinhauer, H. B.; Schumann, Elisa; Lüttgen, F. M.; Schillinger-Pokorny, E.; Schaefer, Franz; Wende, Reuben D.; Offner, G.; Nather, S.; Osten, B; Zimmering, Miriam; Ehrich, J. H. H.; Kehn, M.; Mansmann, U.; Große-Siestrup, Christian

doi:10.1016/s0272-6386(98)70130-1

Cited by 37 publications

(25 citation statements)

References 15 publications

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“…Twardowski und Prowant berichten über ein erhöhtes Risiko von frühen Exit site-Infektionen und auch eine verzögerte Wundheilung nach PD-Katheterimplantation bei übergewichtigen Patienten [11]. In anderen Studien hatte der BMI keinen Einfluss auf die Häufigkeit von Katheter-assoziierten Infektionen [12]. Auch Afthentopoulos und Oreopoulos fanden keinen Unterschied in der Peritonitishäufigkeit bei PD-Patienten mit einem Körperge-wicht von über 80 kg im Vergleich zu leichteren Patienten (Körpergewicht 60-80 kg) [13].…”

Section: Infektiöse Komplikationen Bei Pd-patienten Mit Hohem Bmiunclassified

Peritoneal dialysis in patients with high body-mass index

Schmekal

2005

Wien Klin Wochenschr

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Most physicians do not consider peritoneal dialysis (PD) to be the treatment of choice in obese patients with end-stage renal failure. In some but not all studies the incidence of infectious complications (catheter-associated infections and peritonitis) is higher than in patients with normal body mass index (BMI). Although mathematical models show that even continuous ambulatory PD with a daily dialysate treatment volume of 12 litres does not provide sufficient clearances in patients weighing 80 kg, adequate dialysis has been achieved in clinical studies in patients with BMI up to 46 kg/m2. Residual renal function is a very important factor for survival in patients undergoing PD and might be influenced by body weight; however, data are controversial, showing either a negative influence of high BMI on renal clearance or no association. The incidence of peritoneal leaks in PD is higher in obese patients than in other patients, because of the raised intra-abdominal pressure. In contrast, hernias do not occur more frequently in overweight PD patients and the risk of hernias seems to be greater in patients with lower BMI. It is well known that mortality rates of overweight patients on hemodialysis are lower than in those with normal body weight, but data on the influence of BMI on survival in PD patients are more controversial. In conclusion, there is no evidence that PD is absolutely contraindicated in patients with high BMI, especially if patients have a strong preference for this type of treatment.

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Section: Infektiöse Komplikationen Bei Pd-patienten Mit Hohem Bmiunclassified

Peritoneal dialysis in patients with high body-mass index

Schmekal

2005

Wien Klin Wochenschr

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“…Five randomised controlled trials of varying quality, assessing various applications of povidone‐iodine for effectiveness to prevent infection of the exit‐site or development of peritonitis, met the inclusion criteria 11,29–32 . Due to differences in methodology, these trials could not be combined in a meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“…In a multicentre unblinded RCT of 195 PD patients, a silver ring placed around an existing catheter at the skin level of the exit site was compared to a control group receiving no silver ring 32 . Standard exit‐site care consisting of daily inspection and cleansing of the exit site and change of gauze dressing was performed on both groups during a 12‐month period of the study; 16% of the sample were children.…”

Section: Resultsmentioning

confidence: 99%

Clinical effectiveness of different approaches to peritoneal dialysis catheter exit‐site care

2003

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Executive summary Objective The objective of this review was to appraise and synthesise the best available evidence on the clinical effectiveness of peritoneal dialysis catheter exit‐site care. Inclusion criteria This review considered all randomised controlled trials that evaluated the effectiveness of peritoneal exit‐site care. In the absence of randomised controlled trials, other controlled research designs such as non‐randomised controlled trials were considered for inclusion in a narrative summary to enable the identification of current approaches and possible future strategies. Participants of interest were adults with chronic renal failure on maintenance peritoneal dialysis. Interventions of interest were those used to manage peritoneal catheter exit sites, and included types of dressings, frequency of dressings, types of skin care, and use of topical antiseptic or antimicrobial agents. Search strategy The search sought to find both published and unpublished studies. An initial limited search of MEDLINE and CINAHL databases was undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant articles. A second extensive search was undertaken using all identified key words and index terms. The third step was a search of the reference lists and bibliographies of all relevant articles. Methodological quality All identified studies that met the inclusion criteria were assessed for methodological validity by two reviewers prior to inclusion in the review. Critical appraisal of studies focused on identifying bias in selection, performance, attrition and detection. Results This review found few studies of sufficient quality to meet the inclusion criteria. The included studies often utilised historical control groups, potentially confounding measurement of their outcomes. The outcome measures varied considerably, thus meta‐analysis was not possible. Conclusions This review suggests topical mupirocin may reduce the risk of exit‐site infection; however, the clinical effectiveness of any one antibiotic, antiseptic or dressing procedure was not established for the prevention or reduction of exit‐site infection rates or peritonitis. This review has underlined large gaps in the existing knowledge on the care of exit sites in patients on peritoneal dialysis.

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“…Sixteen of these articles dealt with the effectiveness of forms of exit-site care to prevent infection or peritonitis, and were included. 6,[10][11][12][13][26][27][28][29][30][31][32][33][34][35][36] A summary of the study populations, methods, interventions and outcome measures for the included studies can be found in Appendix III. A further 115 papers were excluded for reasons of wrong study type, review or discussion paper, incorrect outcome(s) or intervention(s) (Appendix IV).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Five randomised controlled trials of varying quality, assessing various applications of povidone-iodine for effectiveness to prevent infection of the exit-site or development of peritonitis, met the inclusion criteria. 11,[29][30][31][32] Due to differences in methodology, these trials could not be combined in a meta-analysis.…”

Section: Povidone-iodinementioning

confidence: 99%

Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care

Lockwood

Hodgkinson

Page

2003

JBI Database of Systematic Reviews and Implementation Reports

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Executive summaryObjective The objective of this review was to appraise and synthesise the best available evidence on the clinical effectiveness of peritoneal dialysis catheter exit-site care. Inclusion criteriaThis review considered all randomised controlled trials that evaluated the effectiveness of peritoneal exit-site care. In the absence of randomised controlled trials, other controlled research designs such as non-randomised controlled trials were considered for inclusion in a narrative summary to enable the identification of current approaches and possible future strategies. Participants of interest were adults with chronic renal failure on maintenance peritoneal dialysis. Interventions of interest were those used to manage peritoneal catheter exit sites, and included types of dressings, frequency of dressings, types of skin care, and use of topical antiseptic or antimicrobial agents. Search strategyThe search sought to find both published and unpublished studies.An initial limited search of MEDLINE and CINAHL databases was undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant articles. A second extensive search was undertaken using all identified key words and index terms. The third step was a search of the reference lists and bibliographies of all relevant articles.Methodological quality All identified studies that met the inclusion criteria were assessed for methodological validity by two reviewers prior to inclusion in the review. Critical appraisal of studies focused on identifying bias in selection, performance, attrition and detection. ResultsThis review found few studies of sufficient quality to meet the inclusion criteria.The included studies often utilised historical control groups, potentially confounding measurement of their outcomes. The outcome measures varied considerably, thus meta-analysis was not possible. ConclusionsThis review suggests topical mupirocin may reduce the risk of exit-site infection; however, the clinical effectiveness of any one antibiotic, antiseptic or dressing 168 C Lockwood et al.

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Effect of a silver device in preventing catheter-related infections in peritoneal dialysis patients: Silver ring prophylaxis at the catheter exit study

Cited by 37 publications

References 15 publications

Peritoneal dialysis in patients with high body-mass index

Peritoneal dialysis in patients with high body-mass index

Clinical effectiveness of different approaches to peritoneal dialysis catheter exit‐site care

Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care

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