SaO013A RANDOMIZED OPEN-LABEL CONTROLLED TRIAL TO COMPARE TOPICAL GENTAMICIN VERSUS ALTERNATING MUPIROCIN AND GENTAMICIN CREAM IN PREVENTING CATHETER-RELATED INFECTION IN PERITONEAL DIALYSIS

Abstract

Introduction and Aims: Catheter-related infection, namely exit site infection and peritonitis, is the major infectious complication and main cause of technique failure in peritoneal dialysis. Topical application of antibiotic cream might reduce catheter-related infection but emergence of resistant or opportunistic organisms could be a concern. Optimal topical agents and regimens remain to be determined. We did a study to examine the effect of an alternating topical antibiotic regimen in preventing catheter-related infection. Methods: We performed a single center, randomized open-label study to compare daily topical application of gentamicin cream with a gentamicin/mupirocin alternate regimen. Patients randomized to alternate regimen were asked to have daily application of gentamicin cream in odd months and mupirocin cream in even months. Primary outcomes are exit site infection and peritonitis. Secondary outcomes are catheter removal or death caused by catheter-related infection. A total of 146 patients (71, gentamicin group; 75 alternate regimen group) were enrolled with a total follow-up duration of 174 and 181 patient-years for gentamicin and alternating groups respectively. All patients were followed up until catheter removal, death, transfer to another unit, transplantation or the end of the study on March 31, 2014. There were no significant differences in the age, sex, dialysis vintage, and rate of diabetes, helper-assisted dialysis and MRSA carriage state. Results: No difference seen in the time to first exit site infection or peritonitis. However, the time to first Gram-negative peritonitis seemed longer for gentamicin group (p=0.055). The two groups showed similar rate of exit site infection (0.178/yr vs 0.193/yr, p=0.627) but P. aeruginosa exit site infection was less common in gentamicin group (0.063/yr vs 0.11/yr, p=0.01). Peritonitis rate was significantly lower in gentamicin group (0.23/yr vs 0.31/yr, p=0.017) with a striking decrease in Gram-negative peritonitis (0.08/yr vs 0.138/yr, p=0.0085), and fungal peritonitis (0.0057/yr vs 0.0276/yr, p=0.0001) which was all antibiotics-related episodes with antecedent use of systemic antibiotics for the treatment catheter-related infection. Catheter-related infection associated catheter removal or death appeared less common in the gentamicin group ( p=0.052). Conclusions: Alternating gentamicin/mupirocin cream application appeared similar in efficacy in preventing exit site infection except for P. aeruginosa as compared to gentamicin alone. However, it was inferior to gentamicin in the prevention of peritonitis, especially Gram-negative infection. It is also not beneficial in reducing fungal peritonitis but associated with a higher incidence of antibiotic related fungal peritonitis.