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Evidence summaries

Antimicrobial Agents for Preventing Peritonitis in Peritoneal Dialysis Patients

Nasal, oral, topical, or intraperitoneal antibiotics may not reduce exit-site/tunnel infection, peritonitis or catheter removal in peritoneal dialysis patients compared with placebo or no treatment. Oral antifungal prophylaxis compared with placebo/no treatment may reduce the risk of fungal peritonitis. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 39 studies with a total of 4 435 subjects. Nasal antibiotics compared with placebo or no treatment did not reduce infection rate or catheter removal T1. Neither did oral, topical or intraperitoneal antibiotics T2 or topical disinfectants T3 reduce infections or catheter removals. . Antifungal prophylaxis with oral nystatin/fluconazole compared with placebo/no treatment may reduce the risk of fungal peritonitis occurring after a patient has had an antibiotic course (2 studies, 817 patients, low quality evidence: RR 0.28, 95% CI 0.12 to 0.63).

Nasal antibiotics versus placebo/no treatment for preventing peritonitis in peritoneal dialysis patients

OutcomeRelative effect (95% CI)Assumed risk - Control- Placebo or no treatmentRisk with intervention (95% CI)No of participants(studies) Quality of evidence
Peritonitis (number of patients with one or more episodes)RR 0.94 (0.67 to 1.31)331 per 1000311 per 1000(222 to 434)338 (3) Low
Exit-site/tunnel infection (number of patients with one or more episodes)RR 1.34 (0.62 to 2.87)188 per 1000252 per 1000(117 to 540)338 (3) Low
Catheter removal or replacement (number of patients)RR 0.92 (0.48 to 1.78)265 per 1000244 per 1000(127 to 472)289 (2) Low

Oral or topical or intraperitoneal antibiotics versus placebo/no treatment for preventing peritonitis in peritoneal dialysis patients

OutcomeRelative effect (95% CI)Assumed risk - Control- Placebo or no treatmentRisk with intervention (95% CI)No of participants(studies) Quality of evidence
Peritonitis (number of patients with one or more episodes)RR 0.82 (0.57 to 1.19)385 per 1000316 per 1000(219 to 458)395 (5) Low
Exit-site/tunnel infection (number of patients with one or more episodes)RR 0.45 (0.19 to 1.04)231 per 1000104 per 1000(44 to 240)191 (3) Low
Catheter removal or replacement (number of patients)RR 0.82 (0.46 to 1.46)156 per 1000128 per 1000(72 to 228)395 (5) Low

Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant) for preventing peritonitis in peritoneal dialysis patients

OutcomeRelative effect (95% CI)Assumed risk - Control- Placebo or no treatmentRisk with intervention (95% CI)No of participants(studies) Quality of evidence
Peritonitis (number of patients with one or more episodes)RR 0.83 (0.65 to 1.06)152 per 1000126 per 1000(99 to 161)853 (6) Low
Exit-site/tunnel infection (number of patients with one or more episodes)RR 0.97 (0.74 to 1.27)222 per 1000215 per 1000(164 to 282)913 (7) Low
Catheter removal or replacement (number of patients)RR 0.89 (0.57 to 1.38)93 per 100083 per 1000(53 to 128)792 (6) Low

Comment: The quality of evidence is downgraded by limitations in study quality (unclear allocation concealment and blinding, incomplete outcome reporting, and selective outcome reporting).

    References

    • Campbell D, Mudge DW, Craig JC et al. Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients. Cochrane Database Syst Rev 2017;4():CD004679. [PubMed]

Primary/Secondary Keywords