作者：CHARMAINE E. LOK, KENNETH E. STANLEY, JANET E. HUX, ROBERT RICHARDSON, SHELDON W. TOBE and JOHN CONLY
来源 ：J Am Soc Nephrol 13: 169–179,
摘要 ：无法采用永久性血管通路的血液透析病人依赖于中央静脉导管 。在这类病人中，导管相关性感染是普遍且严重的并发症。本随机临床试验用来确定在中心静脉导管插入位置使用Polysporin三抗生素软膏是否可以降低导管相关性感染的影响 。在双盲试验中，共有169位通过中心静脉导管进行血液透析的患者随机使用了Polysporin或安慰剂。结果显示 ，在为期六个月的研究阶段内 ，安慰剂组中比使用Polysporin组中病人感染率高 。（34%对12%；相对风险，0.35；95% CI，0.18 对 0.68；P=0.0013），每1000导管使用天数感染的数量(4.10 对 1.02; P=.0001)和每1000导管使用天数的菌血症的数目（2.48 对 0.63; P=0.0004）在安慰剂组都高 。在六个月的研究期内，安慰剂组死亡13例，而Polysporin组有三例死亡（P=0.0041）。综合所有随访信息，患者生存区别数据具有显著意义 (19对9的死亡率; P=0.0027)。在最初的6个月中 ，研究显示，安慰剂组中13个死亡病人有7位发现被感染（54%），相对于Polysporin 组中死亡的3个并没有发现感染 。在中心静脉导管插入的部位局部使用Polysporin抗生素软膏预防感染 ，可以降低感染的发生几率 ，改善血液透析病人的生存率。
J Am Soc Nephrol 13: 169–179, 2003
Hemodialysis Infection Prevention with Polysporin Ointment
CHARMAINE E. LOK,*† KENNETH E. STANLEY,† JANET E. HUX,*
ROBERT RICHARDSON,* SHELDON W. TOBE,* and JOHN CONLY*
*University of Toronto, Toronto, Canada; and †Harvard School of Public Health, Boston, Massachusetts.
Abstract. Hemodialysis patients in whom permanent vascular access cannot be achieved are dependent on a central venous catheter. In such patients, catheter-related infections are a common and serious complication. This study was a randomized clinical trial to determine if topical Polysporin Triple
antibiotic ointment applied to the central venous catheter insertion site could reduce the incidence of catheter-related infections. A total of 169 patients receiving hemodialysis through a central venous catheter were randomized to receive Polysporin Triple or placebo using a double-blind study design. In the 6-mo study period, infections were observed in more patients in the placebo group than in the Polysporin Triple group (34 versus 12%; relative risk, 0.35; 95% CI, 0.18 to 0.68; P _ 0.0013). The number of infections per 1000 catheter days (4.10 versus 1.02; P _ 0.0001) and the number of bacteremias per 1000 catheter days (2.48 versus 0.63; P _ 0.0004) were also greater in the placebo group. Within the 6-mo study period, there were 13 deaths in the placebo group as compared with 3 deaths in the Polysporin Triple group (P _0.0041). When all available follow-up information was included, the difference in survival remained significant (19 versus 9 deaths; P _ 0.0027). Within the first 6 mo, infections were observed in 7 of the 13 placebo subjects who died (54%) as compared with no infections in the three Polysporin Triple subjects who died. The prophylactic application of topical Polysporin Triple antibiotic ointment to the central venous catheter insertion site reduced the rate of infections and was associated with improved survival in hemodialysis patients.