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Feng C, Liu Y, Jin W, Lu M, Su CY. Effect of different exit-site care dressings on preventing peritoneal dialysis related infection from nontropical area: a systematic review and network meta-analysis. Ren Fail 2024; 46:2376331. [PMID: 39011577 PMCID: PMC467103 DOI: 10.1080/0886022x.2024.2376331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/30/2024] [Indexed: 07/17/2024] Open
Abstract
OBJECT This study aims to conduct a systematic review and network meta-analysis to comprehensively evaluate the efficacy of various dressings in preventing exit-site infection (ESI) and peritonitis. METHODS We searched PubMed, Embase, Web of Science, CINAHL Plus with Full Text (EBSCO), Sino Med, Wan Fang Data, China National Knowledge Infrastructure (CNKI) from 1 January 1999 to 10 July 2023. The language restrictions were Chinese and English. Randomized controlled trials, non-randomized controlled trials, and self-controlled trials were included in this study. We used ROB 2 tool to evaluate the quality of the included literature. Two authors independently extracted the data according to the Cochrane Handbook. A Frequentist network meta-analysis was performed using Stata17.0 according to PRISAMA with a random effects model. RESULTS From 2092 potentially eligible studies, thirteen studies were selected for analysis, including nine randomized controlled studies, three quasi-experimental studies and one self-controlled trial. A total of 1229 patients were included to compare five types of exit site care dressings, named disinfection dressings, antibacterial dressings, non-antibacterial occlusive dressings, sterile gauze, and no-particular dressings. The outcome of prevention ESI is antibacterial dressings (SUCRA = 97.6) >non-antibacterial occlusive dressings (SUCRA = 68.3) >disinfection dressings (SUCRA = 50.6) >no-particular dressings (SUCRA = 23.9) >sterile gauze (SUCRA = 9.5). The antibacterial dressings were more effective than sterile gauze (OR = 0.13, 95%CI 0.04∼0.44), and no-particular dressing (OR = 0.18, 95%CI 0.07∼0.50) in preventing ESI; the non-antibacterial occlusive dressings were effective than sterile gauze (OR:0.30, 95%CI 0.16∼0.57). There is no statistical significance between no-particular dressings and other types of dressings in preventing the mature ESI. There is no statistical significance in the effectiveness of five types of dressings in preventing peritonitis. CONCLUSIONS The no-particular dressings maybe more cost-effective for preventing mature ESI. None of the dressings was more effective than another in preventing peritonitis. Then, none of the different types of dressing is strongly recommended for preventing ESI or peritonitis. RegistrationCRD42022366756.
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Affiliation(s)
- Chunyan Feng
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Yue Liu
- Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China
| | - Weiyi Jin
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Mengyuan Lu
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Chun-Yan Su
- Department of Nephrology, Peking University Third Hospital, Beijing, China
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Castiello G, Caravella G, Ghizzardi G, Conte G, Magon A, Fiorini T, Ferraris L, Devecchi S, Calorenne V, Andronache AA, Saracino A, Caruso R. Efficacy of Polyhexamethylene Biguanide in Reducing Post-Operative Infections: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2023; 24:692-702. [PMID: 37870810 DOI: 10.1089/sur.2023.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Background: Post-operative infections are a substantial cause of morbidity and mortality worldwide. Polyhexamethylene biguanide (PHMB) is an antimicrobial agent that has been used in various surgical settings to prevent infections. However, the literature on its efficacy in reducing post-operative infections remains unclear. Materials and Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of PHMB in reducing post-operative infections. The risk of bias and methodologic quality of the included studies were also assessed. Results: The systematic review included nine RCTs, and eight were included in the meta-analysis that showed that the use of PHMB was associated with a reduction in the rate of post-operative infections. The overall effect size was statistically significant, with moderate heterogeneity across the included studies (log Peto's odds ratio [OR], -0.890; 95% confidence interval [CI], -1.411 to -0.369; I2 = 41.89%). However, the diversity in the application of PHMB and the potential influence of other factors, such as adherence to infection prevention protocols and organizational-level variables, underscore the need for further primary studies. Conclusions: Polyhexamethylene biguanide appears to be a promising intervention for reducing post-operative infections. However, more high-quality, well-designed RCTs are needed to confirm these findings and to explore the most effective ways to use PHMB within specific infection prevention bundles. Future research should also aim to control for potential confounding factors to provide a more comprehensive understanding of the efficacy of PHMB in reducing post-operative infections.
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Affiliation(s)
- Gianluca Castiello
- Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giuseppe Caravella
- Pharmacy Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Greta Ghizzardi
- Health Professions Directorate, Bachelor in Nursing Course, ASST Lodi, Lodi, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Tiziana Fiorini
- Health Professions Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Laurenzia Ferraris
- Hospital Infection Control Committee, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Simona Devecchi
- Paediatric Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Veronica Calorenne
- Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Andreea Alina Andronache
- Paediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonio Saracino
- Paediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosario Caruso
- Clinical Research Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Chow KM, Li PKT, Cho Y, Abu-Alfa A, Bavanandan S, Brown EA, Cullis B, Edwards D, Ethier I, Hurst H, Ito Y, de Moraes TP, Morelle J, Runnegar N, Saxena A, So SWY, Tian N, Johnson DW. ISPD Catheter-related Infection Recommendations: 2023 Update. Perit Dial Int 2023; 43:201-219. [PMID: 37232412 DOI: 10.1177/08968608231172740] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. The 2023 updated recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection. A new target for the overall exit site infection rate should be no more than 0.40 episodes per year at risk. The recommendation about topical antibiotic cream or ointment to catheter exit site has been downgraded. New recommendations include clarified suggestion of exit site dressing cover and updated antibiotic treatment duration with emphasis on early clinical monitoring to ascertain duration of therapy. In addition to catheter removal and reinsertion, other catheter interventions including external cuff removal or shaving, and exit site relocation are suggested.
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Affiliation(s)
- Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Ali Abu-Alfa
- Division of Nephrology and Hypertension, American University of Beirut, Lebanon
- Section of Nephrology, Yale School of Medicine, New Haven, CT, USA
| | | | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Imperial College NHS Trust, London, UK
| | - Brett Cullis
- Department of Nephrology and Child Health, University of Cape Town, South Africa
| | - Dawn Edwards
- National Forum of ESRD Networks, Kidney Patient Advisory Council (KPAC), USA
| | - Isabelle Ethier
- Division of Nephrology, Centre hospitalier de l'Université de Montréal, Canada
- Health Innovation and Evaluation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada
| | - Helen Hurst
- School of Health and Society, University of Salford, Salford Royal, Northern Care Alliance Trust, UK
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Thyago Proença de Moraes
- Programa de Pós-Graduação em Ciências da Saúde, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Anjali Saxena
- Department of Medicine, Division of Nephrology, Stanford University, CA, USA
- Department of Medicine, Division of Nephrology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Simon Wai-Yin So
- Department of Pharmacy, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Na Tian
- Department of Nephrology, General Hospital of NingXia Medical University, Yinchuan, China
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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Moghiseh L, Nobahar M, Ghorbani R, Sirafian S. The impact of Propolis on catheter exit site infection and peritonitis in peritoneal Dialysis patients: a clinical trial. BMC Nephrol 2022; 23:408. [PMID: 36564743 PMCID: PMC9789634 DOI: 10.1186/s12882-022-03036-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Peritonitis is one of the major complications of peritoneal dialysis. The most common cause of peritonitis is infection at the catheter exit site. This study aimed to determine the effect of propolis on the incidence of catheter exit site infection and peritonitis in peritoneal dialysis patients. METHOD This study was a double-blind clinical trial (2019-2020) with peritoneal dialysis patients. Ninety peritoneal dialysis patients were allocated to three groups (placebo, control, intervention) using block randomization method. Catheter exit site was washed with 0.9% normal saline and dressing was done every other day after the morning peritoneal dialysis exchange by use of normal saline in placebo, mupirocin in control, and propolis in intervention group, for 6 months. DISCUSSION 10% of the patients in the placebo and 6.7% in the control group developed catheter Exit Site Infection, but none patient in the intervention group developed this infection (P = 0.469). Whereas 6.7% in both the placebo and control groups developed peritonitis, but none patient in the intervention group contracted peritonitis (P = 0.997). No significant differences in the incidence of catheter exit site infection and peritonitis among the three groups were observed. Considering that mupirocin is of chemical origin and may lead to drug resistance whereas propolis is of plant origin and does not produce drug resistance, the use of propolis is recommended. TRIAL REGISTRATION Iranian Registry of Clinical Trials [ IRCT20110427006318N10 ] (17/01/2019).
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Affiliation(s)
- Lila Moghiseh
- grid.486769.20000 0004 0384 8779Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Monir Nobahar
- grid.486769.20000 0004 0384 8779Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran ,grid.486769.20000 0004 0384 8779Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran ,grid.486769.20000 0004 0384 8779Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran ,grid.486769.20000 0004 0384 8779Nursing Care Research Center and Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, 3513138111 Iran
| | - Raheb Ghorbani
- grid.486769.20000 0004 0384 8779Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran ,grid.486769.20000 0004 0384 8779Department of Epidemiology and Biostatistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Shiva Sirafian
- grid.411036.10000 0001 1498 685XIsfahan Kidney Diseases Research Center, Internal Medicine Department, Isfahan University of Medical Sciences, Isfahan, Iran
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Piątkowska E, Paleczny J, Dydak K, Letachowicz K. Antimicrobial activity of hemodialysis catheter lock solutions in relation to other compounds with antiseptic properties. PLoS One 2021; 16:e0258148. [PMID: 34618850 PMCID: PMC8496847 DOI: 10.1371/journal.pone.0258148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022] Open
Abstract
Proper protection of vascular access after haemodialysis is one of the key measures for the prevention of catheter-related infections. Various substances with bactericidal and anticoagulant properties are used to fill catheters, but due to the unsatisfactory clinical effects and occurrence of adverse reactions, the search for new substances is still ongoing. In the present paper, we compared the in vitro antimicrobial activity of solutions used for tunnelled catheter locking (taurolidine, trisodium citrate) and solutions of substances that could potentially be used for this purpose (sodium bicarbonate, polyhexanide-betaine). The studies have been conducted on bacteria that most commonly cause catheter-related infections. The values of both minimum inhibitory concentration and minimum biofilm eradication concentration of the substances were determined. The ability of the tested substances to eradicate biofilm from the dialysis catheter surface was also evaluated. The results showed that polyhexanide-betaine inhibited the growth of all microbes comparably to taurolidine, even after ≥ 32-fold dilution. The activity of trisodium citrate and sodium bicarbonate was significantly lower. Polyhexanide exhibited the highest activity in the eradication of bacterial biofilm on polystyrene plates. The biofilm formed on a polyurethane dialysis catheter was resistant to complete eradication by the test substances. Polyhexanide-betaine and taurolidine showed the highest activity. Inhibition of bacterial growth regardless of species was observed not only at the highest concentration of these compounds but also after dilution 32-128x (taurolidine) and 32-1024x (polyhexanide-betaine). Therefore, it can be assumed that taurolidine application as a locking solution prevents catheter colonization and systemic infection development. Taurolidine displays high antimicrobial efficacy against Gram-positive cocci as well as Gram-negative bacilli. On the contrary, the lowest antibacterial effect displayed product contained sodium bicarbonate. The inhibitions of bacterial growth were not satisfactory to consider it as a substance for colonization prevention. Polyhexanidine-betaine possessed potent inhibitory and biofilm eradication properties comparing to all tested products. PHMB is applied as a wound irrigation solution worldwide. However, based on our results, we assume that the PHMB is a promising substance for catheter locking solutions thanks to its safety and high antimicrobial properties.
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Affiliation(s)
- Elżbieta Piątkowska
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, Wroclaw, Poland
| | - Justyna Paleczny
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, Wroclaw, Poland
| | - Karolina Dydak
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, Wroclaw, Poland
| | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Medical University of Wroclaw, Wroclaw, Poland
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