SUN-080 An efficacy and feasibility study comparing topical use of acetic acid at the exit site versus mupirocin to prevent exit site infections (ESI) in peritoneal dialysis (PD) patients (ACES) Study

Introduction: An efficacy and feasibility study comparing topical use of acetic acid at the exit site versus mupirocin to prevent exit site infections (ESI) in peritoneal dialysis (PD) patients (ACES) Study). Williams, N. Williams, L, Smith D, Wolley M, Ranganathan D, RBWH Peritoneal Dialysis Unit. Australia. Introduction: Exit site infection (ESI) is the major cause of catheter related peritoneal dialysis(PD) peritonitis and catheter loss. Guidelines recommend routine use of Mupirocin at the exit site(ES). Topical Mupirocin has been administered in our unit for the last 13 years. Mupirocin usage can result in antimicrobial resistance and increase the risk of pseudomonas (Ps) infection. We noticed increased incidence of PS related peritonitis in our centre. Carson et al found that acetic acid has in vitro activity against Ps and Fraise et al) demonstrated that acetic acid inhibits both Ps strains as well as MRSA. ISPD guidelines(2017) recommend further studies in the use of acetic acid at the catheter exit site for prevention of ES. Therefore, we performed a study to explore daily topical use of acetic acid as an alternative to mupirocin for the prevention of ESI. Methods: • Single centred non- blinded RCT to assess feasibility/efficacy of acetic acid use • Randomize to either: Group 1 (Treatment Group) Routine exit site cleaning and topical acetic acid (2%) or Group 2 routine exit site cleaning and topical mupirocin, (control group). • Routine exit site cleaning involves: washing the exit site in the shower with sterile gauze with antibacterial soap and water and drying the exit site (ES) • Participants will be followed up at clinic visits and exit site will be examined every 8 weeks either at routine clinic visits or routine home visits. At each visit the exit site will be scored, adopted from ISPD guidelines ((2005). • Participants will be followed up for 12 months with interim analysis at 6 months. • Primary Outcome: ESI Incidence expressed as episodes per patient year and time to first ESI. • Secondary outcome: ESI incidence due to pseudomonas aeruginosa Results: • 6-month interim results are presented • 45 were included and 21 and 24 were randomised to acetic acid group and mupirocin group respectively • 10 withdrew from the study - 6 from acetic acid group (5 patient choice, 1 after ESI) and 4 from mupirocin group (1 patient choice and 3 PD related complications) • At 6 months ESI Rates: Mupirocin: 1:37.1 patient months Acetic Acid: 1:44.4 patient months EOP Rates: Mupirocin: 1:111 patient months Acetic Acid: 1:22 patient months No pseudomonas ESI in either group nor causative for peritonitis Conclusions: At 6 months there was no significant increase in ESI or peritonitis rates in the acetic acid group. Most patients tolerated acetic acid, suggesting a larger trial would be feasible.