Abstract
Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis (PD) patients were not known. We performed a prospective, randomized controlled trial enrolling 89 PD patients. After stratification by initial Staphylococcus aureus (SA) carrier status, patients were randomly assigned to receive daily 4% chlorhexidine care (intervention group) or normal saline (control group) at the exit site. Monthly, we cultured bacteria from the exit site and nasal swabs for 1 year. The SA colonization rates at exit site at 6 and 12 months were significantly lower in the intervention group than the control group (5.0% vs. 22.9%, p = 0.023 and 8.6% vs. 28.1%, p = 0.037 for 6 and 12 months, respectively). The Methicillin-resistant SA (MRSA) colonization rate at exit site at 6 months was similar (5.7% vs. 2.5%,p = 0.596) in control and intervention group, but significantly lower in the intervention group than the control group at exit site at 12months (0% vs. 12.5%, p = 0.047). The gram-negative bacilli (GNB) colonization rates were similar between the intervention and control groups at 6 and 12 months. Genotyping of all MRSA isolates showed ST (sequence type) 59 was the most predominant clone. In conclusion, chlorhexidine care at the exit site in PD patients may be a good strategy for SA and MRSA decolonization.Trial registration: ClinicalTrials.gov NCT02446158
Highlights
There is no consensus on what regimen is optimal for topical care of the peritoneal dialysis (PD) catheter exit site
The underlying disease, age, dialysis duration, dialysis modality, and baseline nasal carrier rate were similar in the control (n = 39) and intervention (n = 50) groups (Table 1)
The Staphylococcus aureus (SA) colonization rates at 6 and 12 months were significantly lower in the intervention group than the control group at the exit site (5.0% vs. 22.9%; p = 0.023 at 6 months; 8.6% vs. 28.1%; p = 0.037 at 12 months)
Summary
There is no consensus on what regimen is optimal for topical care of the peritoneal dialysis (PD) catheter exit site. Cream have been described for care of the exit site [1, 2] Many of these studies were small or short-term and lacked longitudinal evaluation of bacterial decolonization efficacy. The use of chlorhexidine in bathing or central line dressing changes was implemented to prevent bacterial colonization and multidrug resistant bacterial infections [17,18,19] and was used in hemodialysis patients [20]. Data regarding chlorhexidine used in the catheter care of PD patients are limited and it is unclear if the use of chlorhexidine for exit site care contributes to long-term bacterial decolonization and prevent for exit site infections
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