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

Hsi-Hao Wang, Shih-Yuan Hung, Min-Yu Chang, Yi-Che Lee, Hsiu-Fang Lin, Tsun-Mei Lin, Su-Pen Yang, Hsi-Hsun Lin, Su-Ching Yang, Jiun-Ling Wang, Hsi-Hao Wang, Shih-Yuan Hung, Min-Yu Chang, Yi-Che Lee, Hsiu-Fang Lin, Tsun-Mei Lin, Su-Pen Yang, Hsi-Hsun Lin, Su-Ching Yang, Jiun-Ling Wang

Abstract

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.

Trial registration: ClinicalTrials.gov NCT02446158.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Allocation of study patients.
Fig 1. Allocation of study patients.
Fig 2. Kaplan Meir plot of SA…
Fig 2. Kaplan Meir plot of SA colonization at the exit site.
Fig 3. Kaplan Meir plot of GNB…
Fig 3. Kaplan Meir plot of GNB colonization at the exit site.
Fig 4. The PFGE dendrogram with molecular…
Fig 4. The PFGE dendrogram with molecular characterization for nasal and exit site carriage MRSA isolates.
The PFGE cluster was assigned to isolates having 80% or greater similarity from the dendrograms. The blue line indicates the major pulsotype. Cropped gels have been run under the same experimental conditions. Multi-locus sequence typing (MLST). Site: N: nasal; E: exit site.

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