Exit-site care with ciprofloxacin otologic solution prevents polyurethane catheter infection in peritoneal dialysis patients

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 prevent ing exit-site infection (ESI) in PD patients with polyurethane catheters. Design: Prospective study. Setting: Service of Nephrology of an acute-care teaching hospital in Galdac ano, Bizkaia, Spain. Patients: A total of 164 patients with polyurethane catheters inserted was studied from start of continuous ambulatory PD to the end of a 24-month per iod. Patients were divided into two groups according to exit-site treatment protocols. Intervention: Patients in group 1 (n = 86) were instructed on daily exit-si te care with soap and water only; whereas patients in group 2 (n = 78) clea nsed with soap and water, followed by application of a single-dose vial of 0.5 mt ciprofloxacin (1 mg) for application around the insertion site. Main Outcome Measures: Episodes of ESI and peritonitis. Results: There were 67 episodes of ESI among patients in group 1 versus 9 e pisodes among patients in group 2 (p < 0.05), resulting in a rate of 0.41 a nd 0.06 episodes per patient-year of exposure, respectively (p < 0.001). St aphylococcus 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 o ccurred in II patients in group I and in no patients in group 2 (p = 0.05). Peritonitis due to S. aureus ESI was significantly less frequent among pat ients 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). Conclusion: Daily application of ciprofloxacin otologic solution at the exi t site of PD patients with polyurethane catheters inserted significantly re duces the rate of ESI caused by S. aureus and other organisms, particularly P. aeruginosa.