P1204PHROPHYLATIC GENTAMICIN - A THERAPEUTIC WEAPON IN THE COMBAT OF EXIT SITE INFECTIONS IN PERITONEAL DIALYSIS

Abstract

Abstract Background and Aims Infection-related complications, such as exit-site infection (ESI) and peritonitis, are one of the main causes of technique failure and dropout in patients under peritoneal dialysis. Several studies have demonstrated the positive effect of daily topical antibiotics (AB) in preventing ESI. The aim of this study is to demonstrate the impact of topical gentamicin (TG) in preventing ESI, between 2009 and 2019, in a single-center of a medium-sized hospital in Portugal. Method Descriptive and retrospective analysis was performed. Demographic data, comorbidities, type of catheter placement and PD prescription were collected. For each patient, it was determined the time free of prophylactic AB (NTG) and under topical gentamicin (ophthalmic formula, once a day, applied on exit site). ESI cases were identify. Results Eighty-five patients were included, with a mean age of 53.2 ± 14.6 years; 69.5% were male. Cardiovascular comorbidities, like arterial hypertension and diabetes, were highly prevalent (88.2% and 76.5% respectively). Chronic glomerulonephritis and diabetes were the main causes of CKD (19; 22.4%; 15; 17.6%). More than 80% of the patients had previous Nephrology follow up. Percutaneous approach was the first option to catheter placement in 70.6% of the cases and DPA was performed in 53,0%. Every patient started the PD program free of prophylactic AB (n=85); 35 patients started TG at some point. Forty episodes of ESI were recorded, 39 (97.5%) in the NTG group. Staphylococcus aureus was the most frequently identified organism (16; 41.0%), followed by Staphylococcus epidermis (5; 12.5%) and Corynebacterium (5; 12.5%). The Kaplan-Meier analysis demonstrated that patients in TG were associated with better free-time of first peritonitis ((705 vs 985 days; p=0.001). The multivariate Cox regression model confirmed a 14 times higher risk of ESI in NTG group (HR 14.4; 95% CI 1.97-105.45; p=0.001). Conclusion Although mupirocin is still the first option in many centers, some studies have demonstrated a benefic role of gentamicin in reducing ESI, not only by Pseudomonas species but also Staphylococcus aureus. The results of our study confirmed that topical daily gentamicin is highly effective preventing ESI in PD patients. Despite of the concern with the gentamicin-resistant infections, just one patient developed ESI under gentamicin, and the identified microorganism was the Staphylococcus epidermidis.