Hemodialysis Infection Prevention with Polysporin Ointment

Abstract

Abstract. Hemodialysis patients in whom permanent vascular access cannot be achieved are dependent on a central venous catheter. In such patients, catheter-related infections are a common and serious complication. This study was a randomized clinical trial to determine if topical Polysporin Triple antibiotic ointment applied to the central venous catheter insertion site could reduce the incidence of catheter-related infections. A total of 169 patients receiving hemodialysis through a central venous catheter were randomized to receive Polysporin Triple or placebo using a double-blind study design. In the 6-mo study period, infections were observed in more patients in the placebo group than in the Polysporin Triple group (34 versus 12%; relative risk, 0.35; 95% CI, 0.18 to 0.68; P ϭ 0.0013). The number of infections per 1000 catheter days (4.10 versus 1.02; P Ͻ 0.0001) and the number of bacteremias per 1000 catheter days (2.48 versus 0.63; P ϭ 0.0004) were also greater in the placebo group. Within the 6-mo study period, there were 13 deaths in the placebo group as compared with 3 deaths in the Polysporin Triple group (P ϭ 0.0041). When all available follow-up information was included, the difference in survival remained significant (19 versus 9 deaths; P ϭ 0.0027). Within the first 6 mo, infections were observed in 7 of the 13 placebo subjects who died (54%) as compared with no infections in the three Polysporin Triple subjects who died. The prophylactic application of topical Polysporin Triple antibiotic ointment to the central venous catheter insertion site reduced the rate of infections and was associated with improved survival in hemodialysis patients. charmaine.lok@uhn.on.caInfection is the most common cause of morbidity and the second most common cause of death in hemodialysis (HD) patients (1-5). Bacteremia accounts for more than 75% of these infectious deaths (4). Hemodialysis vascular access is implicated as the source of bacteremias in 48 to 73% (3,6 -7) of cases with patients dependent on central venous catheters (CVC) being at highest risk (2,7-9). Currently, approximately 20% of patients are dialyzed using permanent catheters; both their placement rate and length of use has increased (1,4). Staphylococcus aureus has previously been the primary etiologic agent implicated in causing approximately half of the bacteremic episodes (7,10) and 70% of the vascular access site infections (11-12). However, recent studies have reported a greater percentage and variety of Gram-negative bacteria isolated in catheter-related infections (13-16). Polysporin Triple (PT) is an antibiotic ointment composed of 500 U/g bacitracin, 0.25 mg/g gramicidin, and 10,000 U/g polymyxin B and is active topically against most skin flora (e.g., S. aureus, coagulase negative staphylococcus, and most Gram-negative bacteria). Previous studies have demonstrated success in preventing catheter-related infections using topical povidone-iodine (17) or mupirocin (12,18,19), antibiotic or silver-coated catheters (20 -22), and other novel metho...

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

“…In addition, all patients of this study had newly inserted TCCs, and there are doubts whether a similar effect could be documented in patients starting this management after long-term HD. Similar positive results were published by Lok et al with the application of Polysporin ointment (bacitracin, gramicidin, and polymyxin B) or placebo at the exit site [55]. These studies indicate that the application of antibiotic ointments at the exit sites of TCCs might be significant for reducing S. epidermidis-and S. aureus-related CRBs, especially when it is used immediately after TCC insertion.…”

Consensus Guidelines for the Prevention and Treatment of Catheter-Related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update

“…This agent has been shown to be effective in preventing HD catheter-related infections (102). Like gentamicin, Polysporin Triple compound has the advantages of low cost, high tolerability, and low resistance.…”

Nosocomial Infections in Dialysis Access

“…Polysporin antibiotic ointment (bacitracin/gramicidin/polymyxin B) was evaluated in a doubleblind, placebo-controlled, randomized trial including 162 dialysis patients, yielding a significantly lower rate of bacteremia [0.63 catheter-days (treatment group) vs. 2.48/1,000 (placebo group); p = 0.0004]. The time to first bacteremia, infection-related morbidity, and mortality rates also scored favorably in the treatment group [19] . Topical PVI significantly reduced CLABSI incidence as compared to sterile gauze alone (2 vs. 17%, p < 0.01), and this risk reduction was most evident in nasal Staphylococcus aureus carriers [20] .…”