氯己定浸渍海绵敷料预防腹膜透析患者导管出口部位感染的初步研究。
Chlorhexidine-impregnated sponge dressing for prevention of catheter exit-site infection in peritoneal dialysis patients: a pilot study.
机构信息
Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore.
Princess Alexandra Hospital, Brisbane, Australia.
出版信息
Int Urol Nephrol. 2021 Apr;53(4):803-812. doi: 10.1007/s11255-020-02674-w. Epub 2020 Oct 6.
PURPOSE
The study aimed to examine effect of chlorhexidine dressing in the prevention of peritoneal dialysis (PD)-related infection in PD patients.
METHODS
This single-center pilot study recruited 50 incident PD patients to use weekly chlorhexidine dressing. The primary outcome was exit-site/tunnel infection rate. Secondary outcomes were peritonitis rate, time to first PD-related infection, infection-related hospitalization, technique and patient survival, adverse events, and chlorhexidine dressing acceptability. These clinical outcomes were compared with those of a historical cohort (2016-2017) using daily gentamicin cream.
RESULTS
A total of 50 patients were recruited to use chlorhexidine and followed up for one year. The exit-site/tunnel infection rate was 0.09 (95% confidence interval [CI] 0.02-0.22) and peritonitis rate was 0.07 (95% CI 0.01-0.19) episodes per patient-year with chlorhexidine dressing. The 1-year infection-free survival rates for exit-site/tunnel infection and peritonitis were 92% and 94%, respectively. The 1-year technique and patient survival rates were 86% and 96%, respectively. Overall, 12% of participants developed localized contact dermatitis with chlorhexidine. Most participants (73%) reported that chlorhexidine dressings were very acceptable. Compared to a historical cohort using gentamicin cream (n = 238), the chlorhexidine group had similar exit-site/tunnel infection rates (incidence rate ratio [IRR] 0.65, 95% CI 0.22-1.92) but had lower peritonitis rates (IRR 0.24, 95% CI 0.07-0.77), and lower PD infection-related hospitalization rates (IRR 0.21, 95% CI 0.06-0.69) after adjusting for age, sex, race, primary kidney disease, and diabetes mellitus.
CONCLUSION
Weekly chlorhexidine dressing was associated with acceptable PD-related infection outcomes and was well-accepted by patients, although had a 12% rate of delayed localized contact dermatitis.
TRIAL REGISTRATION NUMBER AND DATE
The study was registered under www.clinicaltrials.gov with the reference number of NCT03406520 on 23 January 2018.
目的
本研究旨在探讨氯己定敷料在预防腹膜透析（PD）患者相关感染中的作用。
方法
这项单中心的初步研究招募了 50 例新诊断的 PD 患者，每周使用氯己定敷料。主要结局为出口/隧道感染率。次要结局包括腹膜炎发生率、首次 PD 相关感染时间、感染相关住院率、技术和患者生存率、不良事件和氯己定敷料可接受性。这些临床结局与使用每日庆大霉素乳膏的历史队列（2016-2017 年）进行比较。
结果
共招募了 50 例患者使用氯己定，并随访了一年。氯己定组的出口/隧道感染率为 0.09（95%置信区间[CI] 0.02-0.22），腹膜炎发生率为 0.07（95%CI 0.01-0.19）例/患者-年。出口/隧道感染和腹膜炎的 1 年无感染生存率分别为 92%和 94%。1 年技术和患者生存率分别为 86%和 96%。总体而言，12%的参与者出现局部接触性皮炎。大多数参与者（73%）报告氯己定敷料非常可接受。与使用庆大霉素乳膏的历史队列（n=238）相比，氯己定组的出口/隧道感染率相似（发病率比[IRR]0.65，95%CI 0.22-1.92），但腹膜炎率较低（IRR 0.24，95%CI 0.07-0.77），PD 感染相关住院率较低（IRR 0.21，95%CI 0.06-0.69），调整年龄、性别、种族、原发性肾脏疾病和糖尿病后。
结论
每周使用氯己定敷料与可接受的 PD 相关感染结局相关，且患者易于接受，但有 12%的患者出现迟发性局部接触性皮炎。
试验注册和日期
该研究于 2018 年 1 月 23 日在 www.clinicaltrials.gov 上注册，注册号为 NCT03406520。
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