Abstract
Introduction: Infection is a major complication in patients undergoing peritoneal dialysis (PD). Although daily topical mupirocin effectively prevents peritoneal dialysis-related infections (PDRIs) caused by gram-positive bacteria, it does not provide coverage against gram-negative microorganisms. Meanwhile, gram-negative exit-site infections (ESIs) have become increasingly prevalent in Thailand.
Objectives: This study aimed to evaluate the clinical efficacy of 0.1% gentamicin cream as a substitute for 2% mupirocin ointment for PDRI prophylaxis and to examine its adverse reactions.
Patients and Methods: This study was a historically controlled clinical study conducted between December 2020 and June 2023 to compare outcomes for patients treated with gentamicin cream to those treated with mupirocin ointment. The clinical outcomes assessed were the rates of PDRI and catheter removal.
Results: Thirty participants (median age, 62 years) were analyzed, of which 53.3% were males. Daily application of gentamicin to the exit site significantly reduced the incidence of ESI and the composite rate of ESI and infectious peritonitis compared with mupirocin (0.06 vs 0.51 episodes per patient-year for ESI, P = 0.005 and 0.42 versus 0.88 episodes per patient-year for composite outcomes, P = 0.049, respectively). Although the composite rate of infections was lower in the prospective period, the prophylactic use of topical gentamicin alone did not demonstrate a statistically significant reduction in the incidence of infectious peritonitis specifically (P = 0.722). No tunnel or fungal infections were observed. One patient using gentamicin experienced a non-severe allergic reaction.
Conclusion: Daily topical gentamicin application effectively reduced ESI incidence compared with mupirocin. Therefore, gentamicin appears to be an alternative to mupirocin for ESI prophylaxis, particularly in areas with a high incidence of gram-negative bacterial infections.
Trial Registration: The study was retrospectively registered at the ClinicalTrials.gov on February 13, 2022 (ClinicalTrials.gov ID: NCT05251584; https://clinicaltrials.gov/study/NCT05251584).