Hemodialysis infection prevention with polysporin ointment.
Hemodialysis patients in whom permanent vascular access cannot be achieved are dependent on a central venous catheter. In such patients, catheter-related infections are a common and serious complication. This study was a randomized clinical trial to determine if topical Polysporin Triple antibiotic ointment applied to the central venous catheter insertion site could reduce the incidence of catheter-related infections. A total of 169 patients receiving hemodialysis through a central venous catheter were randomized to receive Polysporin Triple or placebo using a double-blind study design. In the 6-mo study period, infections were observed in more patients in the placebo group than in the Polysporin Triple group (34 versus 12%; relative risk, 0.35; 95% CI, 0.18 to 0.68; P = 0.0013). The number of infections per 1000 catheter days (4.10 versus 1.02; P < 0.0001) and the number of bacteremias per 1000 catheter days (2.48 versus 0.63; P = 0.0004) were also greater in the placebo group. Within the 6-mo study period, there were 13 deaths in the placebo group as compared with 3 deaths in the Polysporin Triple group (P = 0.0041). When all available follow-up information was included, the difference in survival remained significant (19 versus 9 deaths; P = 0.0027). Within the first 6 mo, infections were observed in 7 of the 13 placebo subjects who died (54%) as compared with no infections in the three Polysporin Triple subjects who died. The prophylactic application of topical Polysporin Triple antibiotic ointment to the central venous catheter insertion site reduced the rate of infections and was associated with improved survival in hemodialysis patients.
Lok
Charmaine E
CE
University of Toronto, Toronto, Canada. charmaine.lok@uhn.on.ca
Stanley
Kenneth E
KE
Hux
Janet E
JE
Richardson
Robert
R
Tobe
Sheldon W
SW
Conly
John
J
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001414:Bacitracin / Q000008:administration & dosage*; D016470:Bacteremia / Q000453:epidemiology; D001424:Bacterial Infections / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004311:Double-Blind Method; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009355:Neomycin / Q000008:administration & dosage*; D009824:Ointments; D011112:Polymyxin B / Q000008:administration & dosage*; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000453:epidemiology; D016019:Survival Analysis
D004338:Drug Combinations; D009824:Ointments; D001414:Bacitracin; C001816:bacitracin zinc, neomycin sulfate, polymyxin B, drug combination; D009355:Neomycin; D011112:Polymyxin B