title: Exit-site care with ciprofloxacin otologic solution prevents polyurethane catheter infection in peritoneal dialysis patients.
abstract: OBJECTIVE
  Mupirocin ointment and antiseptics are standard cleansing agents in routine exit-site care of peritoneal dialysis (PD) catheters, but these agents have a deleterious effect on polyurethane devices. We assessed the effectiveness of topical use of ciprofloxacin otologic solution for preventing exit-site infection (ESI) in PD patients with polyurethane catheters.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Service of Nephrology of an acute-care teaching hospital in Galdácano, Bizkaia, Spain.
  
  
  METHODS
  A total of 164 patients with polyurethane catheters inserted was studied from start of continuous ambulatory PD to the end of a 24-month period. Patients were divided into two groups according to exit-site treatment protocols.
  
  
  METHODS
  Patients in group 1 (n = 86) were instructed on daily exit-site care with soap and water only; whereas patients in group 2 (n = 78) cleansed with soap and water, followed by application of a single-dose vial of 0.5 mL ciprofloxacin (1 mg) for application around the insertion site.
  
  
  METHODS
  Episodes of ESI and peritonitis.
  
  
  RESULTS
  There were 67 episodes of ESI among patients in group 1 versus 9 episodes among patients in group 2 (p < 0.05), resulting in a rate of 0.41 and 0.06 episodes per patient-year of exposure, respectively (p < 0.001). Staphylococcus aureus ESI rate was 0.34 in group 1 versus 0.06 in group 2 (p = 0.001). Infections caused by Pseudomonas aeruginosa and other pathogens occurred in 11 patients in group 1 and in no patients in group 2 (p = 0.05). Peritonitis due to S. aureus ESI was significantly less frequent among patients treated with ciprofloxacin (1 vs 9 cases, p = 0.001). Removal of the catheter was necessary in 5 patients in group 1 and in no patients in group 2 (p < 0.05).
  
  
  CONCLUSIONS
  Daily application of ciprofloxacin otologic solution at the exit site of PD patients with polyurethane catheters inserted significantly reduces the rate of ESI caused by S. aureus and other organisms, particularly P. aeruginosa.
authors.affiliation: Service of Nephrology, Hospital de Galdakao, Galdácano, Bizkaia, Spain. jmonten@hgda.osakidetza.net
authors.forename: J
authors.initials: J
authors.lastname: Montenegro
authors.forename: R
authors.initials: R
authors.lastname: Saracho
authors.forename: R
authors.initials: R
authors.lastname: Aguirre
authors.forename: I
authors.initials: I
authors.lastname: Martínez
authors.forename: I
authors.initials: I
authors.lastname: Iribar
authors.forename: J
authors.initials: J
authors.lastname: Ocharán
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D002404:Catheterization / Q000009:adverse effects; D002939:Ciprofloxacin / Q000008:administration & dosage*; D004423:Ear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D019999:Pharmaceutical Solutions / Q000008:administration & dosage; D011140:Polyurethanes; D011446:Prospective Studies
chemical_list: D000890:Anti-Infective Agents; D019999:Pharmaceutical Solutions; D011140:Polyurethanes; D002939:Ciprofloxacin