Chlorhexidine for routine PD catheter exit-site care

Area of Science:

• Nephrology
• Infectious Diseases
• Medical Microbiology

Background:

• Current guidelines recommend mupirocin or gentamicin for peritoneal dialysis (PD) catheter exit-site care.
• The study unit has historically used chlorhexidine gluconate 0.5% for exit-site care.
• A comparison was needed to evaluate the efficacy of mupirocin versus chlorhexidine in preventing PD-related infections.

Purpose of the Study:

• To determine if mupirocin application is superior to chlorhexidine gluconate for preventing exit-site infections (ESIs) and peritonitis in PD patients.
• To compare the incidence of infections between mupirocin and chlorhexidine exit-site care protocols within a specific PD unit.

Main Methods:

• A randomized controlled trial involving stable incident and prevalent PD patients.
• Patients were randomized to receive either mupirocin or chlorhexidine 0.5% for exit-site care.
• The primary endpoint was the first episode of exit-site infection or peritonitis, with follow-up from July 2010 to December 2014.

Main Results:

• Sixty-two patients were randomized (33 mupirocin, 29 chlorhexidine).
• No significant difference in time to first infection (32 months for mupirocin vs. 29 months for chlorhexidine) was observed (p=0.477).
• The incidence of infections was similar between the mupirocin and chlorhexidine groups, despite a higher percentage of diabetic patients in the chlorhexidine group.

Conclusions:

• Mupirocin is not superior to chlorhexidine gluconate 0.5% in preventing exit-site infections and peritonitis in this cohort of PD patients.
• The findings suggest that chlorhexidine may be a viable alternative for PD exit-site care.
• Further research may be warranted to confirm these results in diverse patient populations.