Comparison of gentamicin and mupirocin in the prevention of exit-site infection and peritonitis in peritoneal dialysis.

Exit-site infection (ESI) and peritonitis are the most frequent reasons for catheter removal and patient drop-out from peritoneal dialysis (PD). After a randomized double-blind study showed gentamicin to be superior to mupirocin for exit-site prophylaxis, several dialysis centers including ours switched from topical mupirocin to gentamicin. Our study examined whether the change from mupirocin to gentamicin affected ESI and peritonitis rates. We retrospectively reviewed consecutive charts of patients seen at our PD clinic between January 2003 and December 2007. We noted the rates of ESI and peritonitis in patients who met the study entry criteria. Chart data for the 100 patients that met study entry criteria were evaluated in depth. The ESI rate was 0.002 episodes/patient-month in the gentamicin group and 0.004 episodes/patient-month in the mupirocin group (p = 0.45). The peritonitis rate was 0.06 episodes/patient-month in the gentamicin group and 0.02 episodes/patient-month in the mupirocin group (p = 0.07). The rate of gram-positive peritonitis was 0.05 episodes/ patient-month in the gentamicin group and 0.01 episodes/patient-month in the mupirocin group (p = 0.08). The rate of gram-negative peritonitis was 0.009 episodes/patient-month in the gentamicin group and 0.008 episodes/patient-month in the mupirocin group (p = 0.83). We observed no statistically significant difference in the rates of ESI between patients using mupirocin and those using gentamicin for exit-site prophylaxis. Both groups had a very low ESI rate. A trend toward higher peritonitis rates was noted in the gentamicin group, largely as a result of gram-positive bacteria (p value nonsignificant).