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- Al-Hwiesh, AK, et al.
(author)
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Prevention of peritoneal dialysis catheter infections in Saudi peritoneal dialysis patients: the emergence of high-level mupirocin resistance
- 2013
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In: The International journal of artificial organs. - : SAGE Publications. - 1724-6040 .- 0391-3988. ; 36:7, s. 473-483
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Journal article (peer-reviewed)abstract
- Exit-site infection (ESI) and peritonitis remain the major causes of morbidity and mortality in peritoneal dialysis (PD) patients. This study compared the effectiveness of local mupirocin ointment and gentamicin cream in preventing both gram-positive and gram-negative bacterial infections in PD patients. Methods Patients from two centers (n = 203) were assigned to daily mupirocin ointment or gentamicin cream application. Infections were tracked prospectively by organisms and expressed as episodes per patient-year for both ESI and peritonitis. Results The rate of gram-positive ESI was 0.31/episode/patient-year and 0.22 episodes/patient-year (p<0.05), whereas the rate of gram-negative ESI was 0.28 episode/patient-year and 0.11 episode/patient-year (p<0.01) in the mupirocin group and gentamicin group, respectively. Gram-positive ESI occurred in 17.1% vs 10.2% of patients (p<0.05), whereas 20% of and 5.1% of patients (p<0.001) had gram-negative ESI in the 2 groups respectively. S.aureus was cultured at exit-site in the mupirocin group in 27.8% patients, 60% (16.7% of the total Gram-positive isolates) of them being with high-level mupirocin-resistance. Pseudomonas aeruginosa was cultured in 21.8% of ESI in the mupirocin group, and in only 6.7% in the gentamicin group (p<0.01). Peritonitis rates were lower using gentamicin cream, 0.17 episode/patient-year compared with mupirocin, 0.39 episode/patient-year (p<0.01). With multivariate analysis, only gentamicin exit-site use was a significant predictor for lower catheter infection rate. Conclusion Prolonged use of mupirocin for ESI-prophylaxis is associated with the emergence of mupirocin-resistant S. aureus. Gentamicin cream is superior to mupirocin ointment in the prevention of PD catheter infections.
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- Al-Hwiesh, AK, et al.
(author)
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Metformin in peritoneal dialysis: a pilot experience
- 2014
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In: Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. - : SAGE Publications. - 1718-4304 .- 0896-8608. ; 34:4, s. 368-375
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Journal article (peer-reviewed)abstract
- In a number of patients, the antidiabetic drug metformin has been associated with lactic acidosis. Despite the fact that diabetes mellitus is the most common cause of end-stage renal disease (ESRD) and that peritoneal dialysis (PD) is an expanding modality of treatment, little is known about optimal treatment strategies in the large group of PD patients with diabetes. In patients with ESRD, the use of metformin has been limited because of the perceived risk of lactic acidosis or severe hypoglycemia. However, metformin use is likely to be beneficial, and PD might itself be a safeguard against the alleged complications. Methods Our study involved 35 patients with insulin-dependent type 2 diabetes [median age: 54 years; interquartile range (IQR): 47–59 years] on automated PD (APD) therapy. Patients with additional risk factors for lactic acidosis were excluded. Metformin was introduced at a daily dose in the range 0.5 – 1.0 g. All patients were monitored for glycemic control by blood sugar levels and HbA1c. Plasma lactic acid levels were measured weekly for 4 weeks and then monthly to the end of the study. Plasma and effluent metformin and plasma lactate levels were measured simultaneously. Results In this cohort, the median duration of diabetes was 18 years (IQR: 14 – 21 years), median time on PD was 31 months (IQR: 27 – 36 months), and median HbA1c was 6.8% (IQR: 5.9% – 6.9%). At metformin introduction and at the end of the study, the median anion gap was 11 mmol/L (IQR: 9 – 16 mmol/L) and 12 mmol/L (IQR: 9 – 16 mmol/L; p > 0.05) respectively, median pH was 7.33 (IQR: 7.32 – 7.36) and 7.34 (IQR: 7.32 – 7.36, p > 0.05) respectively, and mean metformin concentration in plasma and peritoneal fluid was 2.57 ± 1.49 mg/L and 2.83 ± 1.7 mg/L respectively. In the group overall, mean lactate was 1.39 ± 0.61 mmol/L, and hyperlactemia (>2 mmol/L to 5 mmol/L) was found in 4 of 525 plasma samples (0.76%), but the patients presented no symptoms. None of the patients registered a plasma lactate level above 5 mmol/L. We observed no correlation between plasma metformin and plasma lactate ( r = 0.27). Conclusions Metformin may be used with caution in APD patients with insulin-dependent type 2 diabetes. Although our study demonstrated the feasibility of metformin use in APD, it was not large enough to demonstrate safety; a large-scale study is needed.
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