Long-term use of a topical antibiotic application at central venous catheter (CVC) exit sites in hemodialysis (HD) patients may result in a sustained decrease in all CVC-related infections, according to a Canadian study.

Charmaine E. Lok, MD, MSc, of the University Health Network-Toronto General Hospital and the University of Toronto, and colleagues studied 228 long-term HD patients using a tunneled cuffed CVC. The researchers prospectively monitored the impact of routine topical polyantibiotic ointment application at CVC exit sites once a week as infection prophylaxis. This infection-control practice was fully implemented at the hospital in 2004. The researchers considered 2003 to be a transition period before full implementation of this protocol as standard care.

The hospital implemented the protocol based on the results of a randomized, double-blind trial (Hemodialysis Infection Prevention with Polysporin Ointment [HIPPO]), which showed that those who received the ointment had improved bacteremia and survival rates compared with those who did not.

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From the transition period to the end of the study (December 31, 2009), 492 CVC-related infections developed in 228 patients, Dr. Lok’s group reported in the American Journal of Kidney Disease (2011;57:432-441). During this time, the overall CVC related infection rate was 0.99 per 1,000 catheter-days and the overall bacteremia rate ranged0.26-0.70 per 1,000 catheter-days. These rates are lower than many reported in the literature, according to the investigators, who noted that a median rate of 3.0-4.0 per 1,000 catheter-days frequently is reported.

With respect to the causative organisms, gram-positive bacteria accounted for 61.2% of exit-site infections and 72.1% of bacteremias, the authors noted.

“Use of a topical polyantibiotic ointment at the CVC exit site with careful surveillance and guidance of infection management by a multidisciplinary team is an effective prophylactic strategy against HD catheter-related infections,” the researchers concluded.