Chlorhexidine for routine PD catheter exit-site care.

Abstract

Although guidelines suggest the routine use of mupirocin or gentamicin at the exit site of PD catheter, our PD unit has been using chlorhexidine gluconate 0.5% as exit-site care protocol. The aim of this study was to ascertain whether mupirocin application is superior to the traditionally applied chlorhexidine-regarding prevention of exit-site infections and peritonitis in our unit. Stable incident and prevalent patients of our unit were randomized to apply mupirocin or chlorhexidine at exit site. The study started on July 1, 2010, and continued till December 2014. End point was the first episode of exit-site infection or peritonitis. Sixty-two patients (mean age 58.5±14.6years) were randomized. At the end of follow-up, there were 33 patients on mupirocin treatment and 29 on chlorhexidine. The two groups had no differences in age, sex, PD vintage or PD mode. The only difference between the two groups was the percentage of patients with diabetes, 28% in chlorhexidine group versus 10% in mupirocin group. Mean time of follow-up was 28.46±16.37months. Twenty-four episodes of infections (peritonitis and exit site) were recorded. Time to first infection episode was 32months in mupirocin group (95% CI 21.4-42.5) versus 29months (95% CI 8.6-49.4) in chlorhexidine group. The Kaplan-Meier survival analysis revealed no difference in the infections between the two protocols (log-rank test, p=0.477). Mupirocin is not superior in preventing infections comparing with chlorhexidine in this cohort of patients.