2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) All Versions of this Article: ASN.2004090773v1 16/2/539    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bernardini, J. Articles by Piraino, B. Search for Related Content PubMed PubMed Citation Articles by Bernardini, J. Articles by Piraino, B.

Randomized, Double-Blind Trial of Antibiotic Exit Site Cream for Prevention of Exit Site Infection in Peritoneal Dialysis Patients

Judith Bernardini^*, Filitsa Bender, Tracey Florio^*, James Sloand, Linda PalmMontalbano, Linda Fried^*, and Beth Piraino^*

^* Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Medicine, West Virginia University, Morgantown, West Virginia; Department of Medicine, University of Rochester Medical Center, Rochester, NY; Veterans Administration Hospital of Pittsburgh, Pittsburgh, Pennsylvania

Address correspondence to: Dr. Beth Piraino, Office of Clinical Affairs, University of Pittsburgh, 3504 Fifth Avenue, Suite 200, Pittsburgh, PA 15213. Phone: 412-383-4896; Fax: 412-383-4898; piraino{at}pitt.edu

Infection is the Achilles heel of peritoneal dialysis. Exit site mupirocin prevents Staphylococcus aureus peritoneal dialysis (PD) infections but does not reduce Pseudomonas aeruginosa or other Gram-negative infections, which are associated with considerable morbidity and sometimes death. Patients from three centers (53% incident to PD and 47% prevalent) were randomized in a double-blinded manner to daily mupirocin or gentamicin cream to the catheter exit site. Infections were tracked prospectively by organism and expressed as episodes per dialysis-year at risk. A total of 133 patients were randomized, 67 to gentamicin and 66 to mupirocin cream. Catheter infection rates were 0.23/yr with gentamicin cream versus 0.54/yr with mupirocin (P = 0.005). Time to first catheter infection was longer using gentamicin (P = 0.03). There were no P. aeruginosa catheter infections using gentamicin compared with 0.11/yr using mupirocin (P < 0.003). S. aureus exit site infections were infrequent in both groups (0.06 and 0.08/yr; P = 0.44). Peritonitis rates were 0.34/yr versus 0.52/yr (P = 0.03), with a striking decrease in Gram-negative peritonitis (0.02/yr versus 0.15/yr; P = 0.003) using gentamicin compared with mupirocin cream, respectively. Gentamicin use was a significant predictor of lower peritonitis rates (relative risk, 0.52; 95% confidence interval, 0.29 to 0.93; P < 0.03), controlling for center and incident versus prevalent patients. Gentamicin cream applied daily to the peritoneal catheter exit site reduced P. aeruginosa and other Gram-negative catheter infections and reduced peritonitis by 35%, particularly Gram-negative organisms. Gentamicin cream was as effective as mupirocin in preventing S. aureus infections. Daily gentamicin cream at the exit site should be the prophylaxis of choice for PD patients.

This article has been cited by other articles:

				D. Scholl and D. W. Martin Jr. Antibacterial Efficacy of R-Type Pyocins towards Pseudomonas aeruginosa in a Murine Peritonitis Model Antimicrob. Agents Chemother., May 1, 2008; 52(5): 1647 - 1652. [Abstract] [Full Text] [PDF]

				P. G. Blake Randomized controlled trials in PD Nephrol. Dial. Transplant., October 1, 2007; 22(10): 2746 - 2748. [Full Text] [PDF]

				N. Aslam, J. Bernardini, L. Fried, R. Burr, and B. Piraino Comparison of Infectious Complications between Incident Hemodialysis and Peritoneal Dialysis Patients Clin. J. Am. Soc. Nephrol., November 1, 2006; 1(6): 1226 - 1233. [Abstract] [Full Text] [PDF]

				R. G. Narins, Participants:, M. Halperin, G. Danovitch, R. Falk, and J. Bargman The Nephrology Quiz and Questionnaire: 2005 Clin. J. Am. Soc. Nephrol., May 1, 2006; 1(3): 592 - 608. [Full Text] [PDF]

				C. T.-S. Lim, K.-S. Wong, and M. W.-Y. Foo The impact of topical mupirocin on peritoneal dialysis infection in Singapore General Hospital Nephrol. Dial. Transplant., October 1, 2005; 20(10): 2202 - 2206. [Abstract] [Full Text] [PDF]

				C. Thiam-Seong Lim, K.-S. Wong, and M. Wai-Yin Foo The impact of topical mupirocin on peritoneal dialysis infection rates in Singapore General Hospital Nephrol. Dial. Transplant., August 1, 2005; 20(8): 1702 - 1706. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673