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Exit Site Topical Prophylaxis Peritonitis Prevention — ESENeph MCQ

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ModeratePeritoneal DialysisExit Site Topical Prophylaxis Peritonitis PreventionESENeph

A 59-year-old man on peritoneal dialysis has been trained on CAPD. He performs 4 exchanges daily using 2 L bags. He is concerned about peritonitis prevention. Which single intervention has the strongest evidence for reducing PD peritonitis rates?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Exit site application of topical mupirocin or gentamicin cream

Topical exit site prophylaxis (mupirocin cream for Staph. aureus carriers, or gentamicin cream for broader coverage) applied to the exit site daily or on alternate days has the strongest evidence base for reducing PD peritonitis rates (ISPD 2022 guidelines, Level 1 evidence). Multiple RCTs demonstrate significant reduction in exit site infections and peritonitis episodes. The HONEYPOT trial showed that daily application of mupirocin to the exit site and nasal mucosa reduced peritonitis by 36% in Staph aureus carriers. Gentamicin cream at the exit site may be more effective against Gram-negative organisms but carries aminoglycoside resistance concerns. This simple, inexpensive intervention is the highest-yield single measure for peritonitis prevention.

Reference: ISPD 2022 – Peritonitis Prevention Guidelines; Johnson et al 2012 – HONEYPOT Trial