Exit-Site Infection of Peritoneal Catheter is Reduced by the Use of Polyhexanide. Results of a Prospective Randomized Trial

Abstract

♦ Background: One of the most common and severe complications affecting peritoneal dialysis (PD) patients is exit-site infection of the peritoneal catheter; it is therefore of vital importance to prevent it. This complication has a negative impact on the success of the technique. In spite of this, there are no clear guidelines concerning how to take care of the exit site. The objective of this study was to assess the efficacy of polyhexanide in preventing exit-site infection over a 12-month period. ♦ Methods: We designed a single-center, prospective, open-labeled, randomized controlled clinical trial with parallel groups. Requirements for participation in the study included implantation of the peritoneal catheter at least six weeks before entering the study and no infectious complications requiring either hospital admission or antibiotic treatment for at least three months before entering into the study. Patients were randomized to be daily cured as follows: Group A: traditional care with saline serum and povidone-iodine; and Group B: polyhexanide solution. Exit sites were evaluated at baseline and every four to six weeks or if any event occurred, according to the Twardowski criteria. ♦ Results: Of the 60 included patients, 46 completed the 12-month follow-up period. Six underwent transplantation, five died and three were transferred to hemodialysis (HD). The treatment was well tolerated, with no side effects nor abandonments due to such effects. Throughout the study period, six patients (20%) undergoing traditional care and only two (6,7%) receiving polyhexanide developed an exit-site infection (p = 0.032). There were a total number of 12 infections; nine occurred in patients following the traditional approach and only three in patients treated with polyhexanide (p = 0.037). The germs responsible for the infections were: S. aureus (six cases), Corynebacterium jeikeium (two cases) and P. aeruginosa (one case) in the saline serum and povidone-iodine group and P. aeruginosa (three cases) in the polyhexanide group. The mean rate of exit-site infection was 1 episode/36.6 patient-months for the traditional care group and 1 episode/102.7 patient-months for the polyhexanide group (p = 0.017). Patients following the traditional treatment required fewer days to get infected than those using polyhexanide (p = 0.033; log rank: 4.2). ♦ Conclusions: These results show that using polyhexanide is efficient for the prevention of exit-site infections. Patients treated with this product suffer from fewer infections and need more time to become infected. Polyhexanide application is painless, no allergies have been described and it is well tolerated by patients. We therefore propose that it may be used routinely from now on for the care of healthy exit site.

ISPD Catheter-Related Infection Recommendations: 2017 Update

“…A small randomized trial reported that topical application of 3% hypertonic saline is as effective as topical mupirocin cream for the prevention of ESI (130). Another study reported that topical polyhexanide resulted in a lower incidence of ESI than povidone-iodine (131). In contrast, topical polyhexamethylene biguanide was inferior to mupirocin in another randomized controlled trial, which was terminated after interim analysis (132).…”

Is On-the-job Training Sufficient for Attaining Standard Nursing Care in Peritoneal Dialysis Centers?

“…Peritonitis remains a major problem in PD, with a substantial percent of patients developing persistent or relapsing infections [4]. To diagnose peritonitis it is important to observe and care for the catheter exit site [5]. In our study the participants' knowledge about diagnosis of peritonitis was deficient prior to our educational program and this improved significantly (P = 0.006) post intervention ( Table 2).…”

“…Catheter and exit-site care are of paramount importance in PD care [5] , [14]. Our nurses' sample needed a lot of education and training in this aspect before attaining significant improvement ( Table 5).…”

Antimicrobial approaches in the prevention ofStaphylococcus aureusinfections: a review

“…Overall fewer exit-site infections were observed in the polyhexanide group than in the povidone–iodine group, and this result was statistically significant ( P = 0.03). In conclusion, more robust and adequately powered studies are needed to be able to draw conclusive statements about the effectiveness of polyhexanide as a prophylactic agent against S. aureus infections 70 …”