Randomized Trial of Povidone Iodine Ointment versus Mupirocin Cream for Prevention of Peritoneal Catheter-Related Infection

Povidone iodine軟膏及mupirocin油膏對腹膜透析病人導管的感染防治效果之比較

巫宏傑(Hung-Chieh Wu) ； 吳志仁(Chih-Jen Wu) ； 陳漢湘(Han-Hsiang Chen) ； 葉瑞圻(Jui-Chi Yeh) ； 陳逸洲(Yi-Chou Chen)

《Acta Nephrologica》 21卷3期 (2007/10) Pp. 211-217

摘要

背景：腹膜透析導管相關的感染，包括出口處感染、隧道感染及腹膜炎等等，常困擾腹膜透析的病人。這個研究的主要目的即在於比較Mupirocin油膏和Povidone iodine軟膏對腹膜透析病人導管感染的防治效果。
方法：將民國九十年到九十四年間，台北馬偕醫院的六十八位剛進入腹膜透析不到三個月的病人，隨機分配成二組，其中一組病人的導管出口處每週約使用二到三次的mupirocin油膏來預防，另一組則使用Povidone iodine軟膏。病人每個月做一次鼻部拭子，共做六個月，借以判斷病人是否為的金黃色葡萄球菌鼻腔帶菌者。感染率用每病人一年發生的頻率（次／病人年）表示，並記載發生感染的菌種。
結果：六十八位剛進入腹膜透析不到三個月的病人中，有三十三位使用mupirocin油膏，三十五位用povidone iodine軟膏，分別總共追綜65及74.25病人一年，平均每人追蹤23.6±13.78 vs. 25.5±13.07月(P=0.506)。導管出口處感染（0.062/年vs. 0.04/年，P=0.34）和腹膜炎（0.231/年vs. 0.242/年，P=0.26）的比率在二個組別無統計意義。金黃色葡萄球菌引起的導管出口處的感染（0.015/年vs. 0.04/年，P=0.354）和綠膿桿菌引起的（0.015/年vs. 0.013/年，P=0.646）亦無顯著差異。其他如革蘭氏陰性菌、革蘭氏陽性菌或黴菌引起導管相關的感染率也無差異。此外，不論是否為金黃色葡萄球菌的鼻腔帶菌者，導管相關的感染率在二個組別也無差異。在研究期間內，並無發生隧道感染或因金黃色葡萄球菌、綠膿桿菌、黴菌引起的腹膜炎。
結論：不論是否為金黃色葡萄球菌的鼻腔帶菌者，使用mupirocin油膏或povidone iodine軟膏在腹膜透析導管感染的防治效果上並無差異。

關鍵字

mupirocin ； povidone iodine ； 出口處感染 ； 腹膜透析

並列摘要

Objectives: To compare topical povidone iodine ointment and mupirocin cream for prevention of chronic ambulatory peritoneal dialysis (CAPD) catheter-related infections.
Methods: A total of 68 patients on CAPD were randomized to mupirocin cream (n=33) or povidone iodine ointment (n=35) applied to the catheter exit site. Infections were recorded by organism and the incidence expressed per patient-years. The prevalence of staphyloccal nasal carriage was assessed.
Results: The overall incidence of exit-site infections (ESI) and peritonitis did not differ significantly between patients using mupirocin and those using povidone iodine (ESI: 0.062/year vs. 0.04/year, P=0.34; peritonitis: 0.231/year vs. 0.242/year P=0.26). The incidence of ESI with S aureus (0.015/year vs. 0.04/ year, P=0.354) or with Pseudomonas aeruginosa (0.015/year vs. 0.013/year, P=0.646) did not differ significantly, nor did the rate of infections due to other bacteria. The incidence of infections did not differ between patients who were and those who were not nasal carriers of S aureus.
Conclusion: There is no difference in the incidence of catheter-related infections in peritoneal dialysis between topical povidone iodine and mupirocin applied to the catheter exit site, regardless whether patients carry S aureus nasally.

並列關鍵字

mupirocin ； povidone iodine ； exit-site infection ； continuous ambulatory peritoneal dialysis