[Antimicrobial agents for preventing peritonitis in peritoneal dialysis: guideline from the Italian Society of Nephrology].
BACKGROUND
The current 3rd edition of the Italian Society of Nephrology guidelines has been drawn up to summarize evidence of key intervention issues on the basis of systematic reviews (SR) of randomized trials (RCT) or RCT data only. The present guideline reports evidence of the use of antimicrobial agents for preventing peritonitis in peritoneal dialysis (PD).


METHODS
SR of RCT and RCT on treatments aiming at preventing peritoneal dialysis peritonitis were identified referring to a Cochrane Library and Renal Health Library search (2005 update). Quality of SR and RCT was assessed according to current methodological standards.


RESULTS
One SR and 19 RCT were found addressing this issue. Staphylococcus Aureus nasal carriage treatment with mupirocin reduces exit-site and tunnel infections but not peritonitis. Topical gentamicin treatment on the exit site reduces Staphylococcus Aureus infection and peritonitis incidence. Intravenous antibiotics administration prior to catheter placement significantly reduces the risk of early peritonitis but not exit-site and tunnel infections. Oral nistatin associated with antibiotic treatment significantly reduces the incidence of Candida peritonitis. No other prophylaxis measure seems to be effective based on available evidence.


CONCLUSIONS
In patients on peritoneal dialysis current evidence supports the hypothesis that topical mupirocin reduces the risk of Staphylococcus Aureus peritonitis, intravenous antibiotics prior to catheter placement prevent the risk of early peritonitis, and oral nistatin reduces the risk of Candida peritonitis. Further studies are necessary to test the effectiveness of other interventions.
Amici
G
G
Italian Society of Nephrology - Italy.
Russo
R
R
Feriani
M
M
Corciulo
R
R
D'Amico
M
M
De Vecchi
A
A
La Milia
V
V
Salomone
M
M
Virga
G
G
Cancarini
G
G
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D006801:Humans; D010530:Peritoneal Dialysis; D010538:Peritonitis / Q000382:microbiology* / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000517:prevention & control*
D000890:Anti-Infective Agents