Universal Exit-Site Antibiotic Prophylaxis Reduces Exit-Site Infections in Pediatric Peritoneal Dialysis

Data on exit-site antibiotic prophylaxis in children undergoing peritoneal dialysis (PD) is scarce.

We conducted a prospective observational cohort study of pediatric patients (aged < 21 years) who received chronic PD 2 years before (preprophylaxis) and/or 3 years after (postprophylaxis) implementing universal exit-site antibiotic prophylaxis. Catheter and exit-site care remained unchanged. The primary outcomes were annualized rates of exit-site infection (ESI), tunnel infection (TI), and peritonitis.

Fifty-seven children (32 girls; 15.1 years, interquartile range: 9.2-17.2) were included. All, except 2 patients underwent automated PD. Thirty-nine and 42 subjects, respectively, received PD during the preprophylaxis and postprophylaxis periods with comparable clinical characteristics. The observation period was 110.0 patient-years. Thirty-seven and 5 patients from the postprophylaxis period received mupirocin and gentamicin, respectively. The annualized ESI or TI rate was significantly lower in the postprophylaxis group (0.17, 95% confidence interval [CI]: 0.07-0.30 vs. 0.46, 95% CI: 0.29-0.68 episodes/patient-yrs; P = 0.003; incidence rate ratio: 0.34, 95% CI: 0.14-0.76; P = 0.004). Annualized rates of gram-positive ESI or TI reduced from 0.35 (95% CI: 0.20-0.54) to 0.10 (95% CI: 0.04-0.23) episodes/patient-yrs (P = 0.007); gram-negative, fungal, and culture-negative ESI or TI rates were similar. Only four peritonitis episodes were reported, with no significant difference between groups. Five catheters were removed in 3 patients because of PD-related infections. Hospitalization days due to PD-related infection were significantly lower in the postprophylaxis group (2.08, 95% CI: 1.72-2.49, vs. 4.22, 95% CI: 3.68-4.81 days/patient-yrs; incidence rate ratio: 0.49, 95% CI: 0.39-0.62; P < 0.001).

Daily exit-site antibiotic prophylaxis prevents gram-positive ESI or TI and shortens hospital stays in children undergoing PD.