Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis patients-A prospective, randomized controlled trial

• Published in: PloS one 2017-10, Vol.12 (10), p.e0184859-e0184859
• Main Authors: Wang, Hsi-Hao, Hung, Shih-Yuan, Chang, Min-Yu, Lee, Yi-Che, Lin, Hsiu-Fang, Lin, Tsun-Mei, Yang, Su-Pen, Lin, Hsi-Hsun, Yang, Su-Ching, Wang, Jiun-Ling
• Format: Article
• Language: English
• Subjects: Antibiotics; Antimicrobial agents; Bacilli; Bacteria; Bacterial infections; Biofilms; Biology and life sciences; Chlorhexidine; Chlorhexidine - administration & dosage; Clinical trials; Colonization; Decolonization; Dialysis; Disease control; Drug resistance; Genotyping; Gram-negative bacilli; Gram-negative bacteria; Humans; Internal medicine; Intervention; Iodine; Laboratories; Medicine; Medicine and health sciences; Methicillin; Patients; Peritoneal Dialysis; Peritoneum; Prospective Studies; Randomization; Staphylococcus aureus; Staphylococcus aureus - growth & development; Staphylococcus aureus - isolation & purification; Staphylococcus infections; Studies
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0184859

Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis (PD) patients were not known. We performed a prospective, randomized controlled trial enrolling 89 PD patients. After stratification by initial Staphylococcus aureus (SA) carrier status, patients were randomly assigned to receive daily 4% chlorhexidine care (intervention group) or normal saline (control group) at the exit site. Monthly, we cultured bacteria from the exit site and nasal swabs for 1 year. The SA colonization rates at exit site at 6 and 12 months were significantly lower in the intervention group than the control group (5.0% vs. 22.9%, p = 0.023 and 8.6% vs. 28.1%, p = 0.037 for 6 and 12 months, respectively). The Methicillin-resistant SA (MRSA) colonization rate at exit site at 6 months was similar (5.7% vs. 2.5%,p = 0.596) in control and intervention group, but significantly lower in the intervention group than the control group at exit site at 12months (0% vs. 12.5%, p = 0.047). The gram-negative bacilli (GNB) colonization rates were similar between the intervention and control groups at 6 and 12 months. Genotyping of all MRSA isolates showed ST (sequence type) 59 was the most predominant clone. In conclusion, chlorhexidine care at the exit site in PD patients may be a good strategy for SA and MRSA decolonization. ClinicalTrials.gov NCT02446158.