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 to 395 participants. Most of the studies were unblinded, small in size and considered to be poorly designed. Meta-analysis was not possible for any of the comparison groups.
Antibiotics
Five trials reported on the effectiveness of three antibiotics (mupirocin, ciproflaxin and sodium fusidate) and produced mixed results on their effectiveness when used as prophylaxis for exit-site infections and perionitis. Studies that relied on historical controls were favourable for topical application of mupriocin and ciprofloxacin. A single prospective RCT found no difference between placebo and sodium fusidate for exit-site infection or peritonitis.
Antiseptics
Nine studies looked at antiseptic treatments applied to the catheter exit-site. Five RCTs tested various applications of povidone-iodine, two studies tested a silver ring, and one study tested each of sodium-hypochlorite and hydrogen peroxide.
Mixed results were observed for the effectiveness of povidone-iodine in preventing exit-site infection and peritonitis. Two RCTs found a beneficial effect over soap and water regimes, but no benefit in comparison with covering the exit-site with gauze. A one-year study found no benefit of povidone-iodine spray over standard dressing. A further study found no benefit from an ointment in comparison with two other antibiotics.
There was no evidence that a silver ring placed in contact with the catheter exit-site was effective in reducing or preventing infections or peritonitis when compared with no additional treatment or standard care.
Dressings
Five studies looked at the use of or comparative effectiveness of dressings to reduce or prevent exit-site infections and peritonitis. The results were mixed and no individual dressing technique could be recommended over any other.