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Exit-site care with ciprofloxacin otologic solution prevents polyurethane catheter infection in peritoneal dialysis
J Montenegro1, R Saracho, R Aguirre
1Service of Nephrology, Hospital de Galdakao, Galdácano, Bizkaia, Spain. jmonten@hgda.osakidetza.net
Objective:
Mupirocin ointment and antiseptics are standard cleansing agents in routine exit-site care of peritoneal dialysis (PD) catheters, but these agents have a deleterious effect on polyurethane devices. We assessed the effectiveness of topical use of ciprofloxacin otologic solution for preventing exit-site infection (ESI) in PD patients with polyurethane catheters.
Design:
Prospective study.
Setting:
Service of Nephrology of an acute-care teaching hospital in Galdácano, Bizkaia, Spain.
Patients:
A total of 164 patients with polyurethane catheters inserted was studied from start of continuous ambulatory PD to the end of a 24-month period. Patients were divided into two groups according to exit-site treatment protocols.
Intervention:
Patients in group 1 (n = 86) were instructed on daily exit-site care with soap and water only; whereas patients in group 2 (n = 78) cleansed with soap and water, followed by application of a single-dose vial of 0.5 mL ciprofloxacin (1 mg) for application around the insertion site.
Main Outcome Measures:
Episodes of ESI and peritonitis.
Results:
There were 67 episodes of ESI among patients in group 1 versus 9 episodes among patients in group 2 (p < 0.05), resulting in a rate of 0.41 and 0.06 episodes per patient-year of exposure, respectively (p < 0.001). Staphylococcus aureus ESI rate was 0.34 in group 1 versus 0.06 in group 2 (p = 0.001). Infections caused by Pseudomonas aeruginosa and other pathogens occurred in 11 patients in group 1 and in no patients in group 2 (p = 0.05). Peritonitis due to S. aureus ESI was significantly less frequent among patients treated with ciprofloxacin (1 vs 9 cases, p = 0.001). Removal of the catheter was necessary in 5 patients in group 1 and in no patients in group 2 (p < 0.05).
Conclusion:
Daily application of ciprofloxacin otologic solution at the exit site of PD patients with polyurethane catheters inserted significantly reduces the rate of ESI caused by S. aureus and other organisms, particularly P. aeruginosa.
Insights
Topical ciprofloxacin otologic solution effectively prevents exit-site infections (ESI) in peritoneal dialysis (PD) patients with polyurethane catheters. This treatment significantly reduced Staphylococcus aureus and Pseudomonas aeruginosa ESI rates compared to standard care.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Devices
Background:
- Standard exit-site care for peritoneal dialysis (PD) catheters often uses mupirocin ointment or antiseptics, which can damage polyurethane materials.
- Exit-site infections (ESI) are a common complication in PD patients, potentially leading to peritonitis and catheter removal.
Purpose of the Study:
- To evaluate the efficacy of topical ciprofloxacin otologic solution in preventing ESI in PD patients using polyurethane catheters.
- To compare ESI rates between patients treated with ciprofloxacin and those receiving standard care.
Main Methods:
- A prospective study involving 164 PD patients with polyurethane catheters over 24 months.
- Patients were divided into two groups: Group 1 (n=86) received soap and water cleansing only; Group 2 (n=78) received soap and water plus daily application of ciprofloxacin otologic solution.
Main Results:
- Group 2 showed a significantly lower ESI rate (0.06 episodes/patient-year) compared to Group 1 (0.41 episodes/patient-year).
- Ciprofloxacin significantly reduced ESI caused by Staphylococcus aureus and Pseudomonas aeruginosa.
- Peritonitis and catheter removal rates were also significantly lower in the ciprofloxacin group.
Conclusions:
- Topical ciprofloxacin otologic solution is an effective strategy for preventing ESI in PD patients with polyurethane catheters.
- This intervention significantly reduces infections caused by S. aureus and P. aeruginosa, improving patient outcomes.