title: Long-Term Exit-Site Gentamicin Prophylaxis and Gentamicin Resistance in a Peritoneal Dialysis Program.
abstract: ♦
  
  
  
  Daily gentamicin cream exit-site prophylaxis reduces peritoneal dialysis (PD)-related gram-negative infections. However, there is a concern about the potential for increasing gentamicin resistance with the long-term use of prophylactic gentamicin. This study evaluated the incidence of gentamicin-resistant PD-related infections over more than 2 decades. ♦
  
  
  
  Study data on prevalent PD patients were retrieved from a prospectively maintained institutional review board (IRB)-approved PD registry at a single center from January 1, 1991, to December 31, 2000, and January 1, 2004, to December 31, 2013. The rates of gram-negative infections, fungal infections and those infections with organisms resistant to gentamicin were examined for the 2 periods. Period 1 from 1991 to 2000 when S. aureus prophylaxis consisted initially of oral rifampin to treat nasal carriage with S. aureus, and was then daily exit-site mupirocin ointment for all PD patients, was compared to the period from 2004 to 2013 when daily exit-site gentamicin cream was prescribed as prophylaxis (Period 2). ♦
  
  
  
  The study included a total of 444 PD patients (265 and 179 in Period 1 and Period 2, respectively). No significant difference was noted in demographics between the 2 periods except race. The gram-negative exit-site infection rates for Period 1 and Period 2 were 0.109 versus 0.027 (p < 0.0001). Gram-negative peritonitis rates were similar. There were 3 episodes of gentamicin-resistant infections in each period. Fungal infections remained consistently low. ♦
  
  
  
  Despite a decade of exit-site gentamicin prophylaxis, gentamicin-resistant PD-related infections and fungal infections remained very low and similar to the prior period.
authors.affiliation: Nephrology Division, Department of Medicine at the University of New Mexico School of Medicine, Albuquerque, NM, USA SSChen@salud.unm.edu.
authors.forename: Shan Shan
authors.initials: SS
authors.lastname: Chen
authors.affiliation: Renal-Electrolyte Division, Department of Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Heena
authors.initials: H
authors.lastname: Sheth
authors.affiliation: Renal-Electrolyte Division, Department of Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Piraino
authors.affiliation: Renal-Electrolyte Division, Department of Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Filitsa
authors.initials: F
authors.lastname: Bender
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D055499:Catheter-Related Infections / Q000382:microbiology / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D010538:Peritonitis / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins
keywords: Exit-site infection; gentamicin cream; gentamicin-resistant; peritoneal dialysis; peritonitis; prophylaxis