SCM15: Exit Site Gentamicin Use and PD-related Infections

Chen, Shan ShanDr. Shan Shan Chen (SSC), from University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, discusses her abstract for the National Kidney Foundation’s 2015 Spring Clinical Meetings (SCM15), Exit Site Gentamicin Prophylaxis Does Not Increase PD Related Gentamicin Resistant (GR) Infections, with Dr. Kenar Jhaveri, AJKD Blog Editor.

AJKDblog: Why don’t you tell us a little about your research and abstract being presented at the NKF 2015 Spring Meetings?

SSC: Previous randomized trial showed that application of gentamicin cream at the exit site (ES) of PD catheter was more effective in preventing gram negative (GN) PD related infection and had similar efficacy in S. aureus prophylaxis. However, there are concerns about increase risk of candida and gentamicin resistant (GR) PD related infections with long term gentamicin prophylaxis. There are only a few studies for those concerns in the literature. We conducted a study that was a retrospective review of prospectively collected data through a PD registry at a single center from 1/1/1991 to 12/31/2013 to evaluate those concerns. There were altogether 473 patients in our study with the mean age of 51.3 year + 15.8, 54% women, 36% DM, Mean Charlson Comorbidity Score of 5 and albumin level 3.54 g/dL + 0.58. The patients from 1989 to 2001 received prophylaxis care with rifampin or ES mupirocin. 2001 to 2003 was the period of randomized control trial for gentamicin versus mupirocin cream. After 2004, gentamicin cream prophylaxis was initiated. In our study, GN peritonitis and exit site infection (ESI) rates were 0.1 and 0.08 respectively. GN ESI decreased significantly after initiation of gentamicin prophylaxis. There were similar numbers of cases (3 patients) of GR GN PD related infections and low rate of candida infection prior to and during the use of gentamicin prophylaxis. We concluded that gentamicin ES prophylaxis doesn’t increase candida or GR GN PD related infections.

AJKDblog: Why do you think the GN Peritonitis rates didn’t change?

SSC: We think it is because if someone had a serious GN ESI especially Pseudomonas, we would remove the catheter to prevent peritonitis when there is no response to antibiotics. It can also be due to infections from different sources other than exit site such as translocation of GN bacteria from bowel or from the PD catheter.

AJKDblog: Where do you and your group go from here?

SSC: We will continue using gentamicin cream as exit site prophylaxis for our patients, focusing on protocol for quality care of exit site and tracking PD-related infection rates. We hope this study will encourage PD programs to examine their infection data and if appropriate, use gentamicin cream for exit site prophylaxis.

Click here for a full list of SCM15 abstracts of poster presentations.

Check out more AJKDblog coverage of the NKF’s 2015 Spring Clinical Meetings!

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