Comparative Effectiveness of Local Application of Chlorhexidine Gluconate, Mupirocin Ointment, and Normal Saline for the Prevention of Peritoneal Dialysis-related Infections (COSMO-PD Trial): a multicenter randomized, double-blind, controlled protocol

This study is a randomized, double-blind, multicenter, active-controlled, clinical trial. Adult patients aged 18 years or older who have end-stage kidney disease and are undergoing PD will be enrolled at three PD Centers in Thailand. A total of 354 PD patients will be randomly assigned to either the 2% chlorhexidine gluconate-impregnated patch, mupirocin ointment, or usual exit-site care with normal saline dressing according to a computer-generated random allocation sequence. Participants will be followed until discontinuation of PD or completion of 24  months. The primary study outcomes are time to first PD-related infection (exit-site/tunnel infection or peritonitis) event and the overall difference in PD-related infection rates between study arms. Secondary study outcomes will include (i) the rate of infection-related catheter removal and PD technique failure, (ii) rate of nasal and exit-siteStaphylococcus aureus colonization, (iii) healthcare costs, and (iv) skin reactions and adverse events. We plan to conduct a cost-utility analysis alongside the trial from the perspectives of patients and society. A Markov simulation model will be used to estimate the total cost and health outcome in terms of quality-adjusted life years (QALYs) over a 20-year time horizon. An incremental cost-effectiveness ratio in Thai Baht and U.S. dollars per QALYs gained will be illustrated. A series of probabilistic sensitivity analyses will be conducted to assess the robustness of the cost...
Source: Trials - Category: Research Source Type: clinical trials

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AbstractHigh levels of antimicrobial drug resistance deleteriously affecting the outcome of treatment with antibacterial agents are causing increasing concern worldwide. This is particularly worrying in patients with cirrhosis with a depressed immune system and heightened susceptibility to infection. Antibiotics have to be started early before results of microbiological culture are available. Current guidelines for the empirical choice of antibiotics in this situation are not very helpful, and embracing antimicrobial stewardship including rapid de-escalation of therapy are not sufficiently emphasised. Multi-drug resistant ...
Source: Hepatology International - Category: Infectious Diseases Source Type: research
We describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
This study aimed to characterize 27 Escherichia coli isolates obtained from peritoneal dialysis (PD)-related peritonitis that occurred at the University Hospital of Botucatu Medical School, Brazil, between 1997 and 2015. METHODOLOGY: These isolates were characterized regarding the occurrence of 22 virulence factor-encoding genes, antimicrobial resistance and biofilm production. We then evaluated whether these factors influenced the clinical outcome. RESULTS: Over an 18-year period, 726 episodes of PD-related peritonitis were diagnosed, with 27 of them (3.7 %) being due to E. coli. The majority of the isolates w...
Source: Journal of Medical Microbiology - Category: Microbiology Authors: Tags: J Med Microbiol Source Type: research
ConclusionThe genome sequence of A. baumannii strain Ab174 can be used as a reference sequence for the new ST1688. This data will facilitate further understanding of genomic variation in A. baumannii isolates from different geographical regions.
Source: Journal of Global Antimicrobial Resistance - Category: Infectious Diseases Source Type: research
Julija Armalytė1, Jūratė Skerniškytė1, Elena Bakienė1, Renatas Krasauskas1, Rita Šiugždinienė2, Violeta Kareivienė2, Sigita Kerzienė2, Irena Klimienė2, Edita Sužiedėlienė1 and Modestas Ružauskas2* 1Life Sciences Center, Institute of Biosciences, Vilnius University, Vilnius, Lithuania 2Institute of Microbiology and Virology, Lithuanian University of Health Sciences, Kaunas, Lithuania Soil is one of the biggest reservoirs of microbial diversity, yet the processes that define the community dynamics are not fully understood. Apart from soil management being vital for agricultural purposes...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
Conclusion Genomic analyses herein performed allowed us to confirm the recently (Pérez-Cataluña et al., 2018a,b) suggested amendment of A. butzleri as Al. butzlerii, comb. nov. Antimicrobial susceptibility tests defined Ab 55 and Ab 6V strains as resistant to vancomycin, tetracyclin, nalidixic acid (only Ab 55 whereas Ab 6V is intermediate resistant), erythromycin, and β-lactam antibiotics. Moreover, in our strains isolated from shellfish, we identified numerous virulence, antibiotic, and heavy metal resistance determinants, also additional to those previously found in the genome sequenced A. butzleri ...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
We report a rare case of carbapenemase-producing enterobacte-riaceae peritonitis in a patient undergoing automated peritoneal dialysis (APD). The PD catheter had to be removed as the patient remained unwell despite antibiotics. Antimicrobial resistance in PD peritonitis is a concern in this era of multi-drug resistant bacteria. PMID: 30692237 [PubMed - in process]
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
CONCLUSION: Spontaneous bacterial peritonitis is one the most important complication in patients with cirrhosis. A proper empiric therapy is crucial to have a positive outcome. In this respect, a careful assessment of risk factors for multidrug-resistant pathogens is crucial. Likewise important, mostly in nosocomial cases, is not overlook the probability of a fungal ascitic infection, namely a spontaneous fungal peritonitis. PMID: 30514194 [PubMed - as supplied by publisher]
Source: Reviews on Recent Clinical Trials - Category: Cancer & Oncology Authors: Tags: Rev Recent Clin Trials Source Type: research
Conclusion: Early diagnosis and appropriate management of the infections will help to prevent the morbidity and mortality associated with these infections. PMID: 30483371 [PubMed]
Source: Iranian Journal of Microbiology - Category: Microbiology Tags: Iran J Microbiol Source Type: research
ConclusionsThe prevalence of ceftriaxone-resistant SBP was significant at a US tertiary centre. Local epidemiological data and identification of risk factors associated with ceftriaxone-resistant SBP, e.g. increased usage of previous β-lactam therapy and invasive gastrointestinal procedure, may help clinicians identify patients requiring alternative empirical antibiotics.
Source: Journal of Global Antimicrobial Resistance - Category: Infectious Diseases Source Type: research
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