Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care Lockwood C, Hodgkinson B, Page T CRD summary This well-conducted review concluded that topical mupirocin antibiotic may reduce the risk of exit-site infection in patients with peritoneal dialysis catheters, but that there was little evidence to support any particular antibiotic, antiseptic or dressing intervention. These conclusions are likely to be reliable and highlight the need for further high- quality research. Authors' objectives To appraise the clinical effectiveness of peritoneal dialysis catheter exit-site care. Searching The following databases were searched from inception up to September 2002: CINAHL, PubMed, Current Contents, The Cochrane Library, Expanded Academic Index and EMBASE. Two additional databases were searched for unpublished studies. Search terms were reported. Reference lists of relevant articles were checked. Study selection Randomised controlled trials (RCTs) that evaluated the effectiveness of peritoneal exit-site care were the study design of primary interest, but non-RCTs and before/after studies were also considered for inclusion. Eligible participants were adults (over 18 years) with chronic renal failure receiving maintenance peritoneal dialysis. Relevant interventions included exit-site dressings, skin care regimes, patient education, and prophylactic topical antimicrobial or antiseptic agents. Key outcomes were defined as exit-site infection rates and peritonitis (detailed definitions provided). The included studies were of various designs. Most studies examined the effectiveness of home care interventions. Interventions were grouped as antibiotics, antiseptics, or types of dressing. No studies evaluating patient education were identified. Infection rates were reported as episodes per patient year, or as episodes per dialysis year. Two independent reviewers selected studies for inclusion. Assessment of study quality Only studies meeting the following minimum criteria were included for any meta-analyses: randomisation, no additional treatment, outcome measurement, and comparability at baseline. Studies were also assessed on additional criteria around selection, performance, attrition and detection biases. Allocation concealment was rated according to Cochrane criteria. NHMRC (National Health and Medical Research Council, Australia) guidelines were used to allocate levels of evidence to the conclusions. Two independent reviewers assessed the methodological quality of included studies. Data extraction Two independent reviewers extracted data using a standardised form. It was intended to group studies into early post- operative period and long-term period, but this was not possible due to the nature of the included studies. Methods of synthesis Studies were assessed for comparability based on study population, intervention and outcomes measured. Heterogeneity was formally assessed using Χ² and visual inspection of forest plots; it was considered to be significant where the p- value was less than 0.05. Dichotomous data were summarised using odds ratios and relative risks. Continuous data were summarised using weighted mean differences or standardised mean differences as appropriate. Where statistical pooling was not possible, a narrative synthesis was presented. Results of the review Sixteen studies were included in the review (1,792 participants): three historically controlled trials, two pseudo-RCTs, eight unblinded RCTs, one controlled trial, and one pre/post trial without a control group. Sample sizes ranged from 13 Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2017 University of York Page: 1 / 3