Scolaris Content Display Scolaris Content Display

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 1 Peritonitis (number of patients with one or more episodes).
Figures and Tables -
Analysis 1.1

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 1 Peritonitis (number of patients with one or more episodes).

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 2 Peritonitis rate (episodes/total patient‐months on PD).
Figures and Tables -
Analysis 1.2

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 2 Peritonitis rate (episodes/total patient‐months on PD).

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 3 Exit‐site/tunnel infection (number of patients with one or more episodes).
Figures and Tables -
Analysis 1.3

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 3 Exit‐site/tunnel infection (number of patients with one or more episodes).

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 4 Exit‐site/tunnel infection rate (episodes/total patient‐months on PD).
Figures and Tables -
Analysis 1.4

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 4 Exit‐site/tunnel infection rate (episodes/total patient‐months on PD).

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 5 Catheter removal or replacement (number of patients).
Figures and Tables -
Analysis 1.5

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 5 Catheter removal or replacement (number of patients).

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 6 Mortality (all‐cause).
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Analysis 1.6

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 6 Mortality (all‐cause).

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 7 Mortality due to peritonitis.
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Analysis 1.7

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 7 Mortality due to peritonitis.

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 8 Adverse effects.
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Analysis 1.8

Comparison 1 Oral or topical antibiotics versus placebo/no treatment, Outcome 8 Adverse effects.

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 1 Peritonitis (number of patients with one or more episodes).
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Analysis 2.1

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 1 Peritonitis (number of patients with one or more episodes).

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 2 Peritonitis rate (episodes/total patient‐months on PD).
Figures and Tables -
Analysis 2.2

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 2 Peritonitis rate (episodes/total patient‐months on PD).

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 3 Exit‐site/tunnel infection (number of patients with one or more episodes).
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Analysis 2.3

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 3 Exit‐site/tunnel infection (number of patients with one or more episodes).

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 4 Exit‐site/tunnel infection rate (episodes/total patient‐months on PD).
Figures and Tables -
Analysis 2.4

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 4 Exit‐site/tunnel infection rate (episodes/total patient‐months on PD).

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 5 Catheter removal or replacement (number of patients).
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Analysis 2.5

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 5 Catheter removal or replacement (number of patients).

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 6 Mortality (all‐cause).
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Analysis 2.6

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 6 Mortality (all‐cause).

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 7 Technique failure.
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Analysis 2.7

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 7 Technique failure.

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 8 Adverse effects.
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Analysis 2.8

Comparison 2 Oral or topical antibiotics versus other antibiotic, Outcome 8 Adverse effects.

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 1 Peritonitis (number of patients with one or more episodes).
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Analysis 3.1

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 1 Peritonitis (number of patients with one or more episodes).

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 2 Peritonitis rate (episodes/total patient‐months on PD).
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Analysis 3.2

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 2 Peritonitis rate (episodes/total patient‐months on PD).

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 3 Exit site and tunnel infection (number of patients with one or more episodes).
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Analysis 3.3

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 3 Exit site and tunnel infection (number of patients with one or more episodes).

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 4 Exit site and tunnel infection rate (episodes/total patient‐months on PD).
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Analysis 3.4

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 4 Exit site and tunnel infection rate (episodes/total patient‐months on PD).

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 5 Catheter removal or replacement (number of patients).
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Analysis 3.5

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 5 Catheter removal or replacement (number of patients).

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 6 Mortality (all‐cause).
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Analysis 3.6

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 6 Mortality (all‐cause).

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 7 Adverse effects.
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Analysis 3.7

Comparison 3 Nasal antibiotics versus placebo/no treatment, Outcome 7 Adverse effects.

Comparison 4 Pre/peri‐operative prophylaxis versus placebo/no treatment or other antibiotic, Outcome 1 Peritonitis (number of patients with one or more episodes).
Figures and Tables -
Analysis 4.1

Comparison 4 Pre/peri‐operative prophylaxis versus placebo/no treatment or other antibiotic, Outcome 1 Peritonitis (number of patients with one or more episodes).

Comparison 4 Pre/peri‐operative prophylaxis versus placebo/no treatment or other antibiotic, Outcome 2 Exit site/tunnel infection (number of patients with one or more episodes).
Figures and Tables -
Analysis 4.2

Comparison 4 Pre/peri‐operative prophylaxis versus placebo/no treatment or other antibiotic, Outcome 2 Exit site/tunnel infection (number of patients with one or more episodes).

Comparison 4 Pre/peri‐operative prophylaxis versus placebo/no treatment or other antibiotic, Outcome 3 Catheter removal or replacement (number of patients).
Figures and Tables -
Analysis 4.3

Comparison 4 Pre/peri‐operative prophylaxis versus placebo/no treatment or other antibiotic, Outcome 3 Catheter removal or replacement (number of patients).

Comparison 4 Pre/peri‐operative prophylaxis versus placebo/no treatment or other antibiotic, Outcome 4 Mortality (all‐cause).
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Analysis 4.4

Comparison 4 Pre/peri‐operative prophylaxis versus placebo/no treatment or other antibiotic, Outcome 4 Mortality (all‐cause).

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 1 Peritonitis (number of patients with one or more episodes).
Figures and Tables -
Analysis 5.1

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 1 Peritonitis (number of patients with one or more episodes).

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 2 Exit site/tunnel infection (number of patients with one or more episodes).
Figures and Tables -
Analysis 5.2

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 2 Exit site/tunnel infection (number of patients with one or more episodes).

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 3 Exit site/tunnel infection rate (episodes/total patient‐months on PD).
Figures and Tables -
Analysis 5.3

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 3 Exit site/tunnel infection rate (episodes/total patient‐months on PD).

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 4 Catheter removal or replacement (number of patients).
Figures and Tables -
Analysis 5.4

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 4 Catheter removal or replacement (number of patients).

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 5 Mortality (all‐cause).
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Analysis 5.5

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 5 Mortality (all‐cause).

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 6 Technique failure.
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Analysis 5.6

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 6 Technique failure.

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 7 Pruritus (local).
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Analysis 5.7

Comparison 5 Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant), Outcome 7 Pruritus (local).

Comparison 6 Germicidal chamber versus none, Outcome 1 Peritonitis rate (episodes/total patient‐months on PD).
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Analysis 6.1

Comparison 6 Germicidal chamber versus none, Outcome 1 Peritonitis rate (episodes/total patient‐months on PD).

Comparison 6 Germicidal chamber versus none, Outcome 2 Mortality (all‐cause).
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Analysis 6.2

Comparison 6 Germicidal chamber versus none, Outcome 2 Mortality (all‐cause).

Comparison 7 Dressing systems (any), Outcome 1 Exit site/tunnel infection (number of patients with one or more episodes).
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Analysis 7.1

Comparison 7 Dressing systems (any), Outcome 1 Exit site/tunnel infection (number of patients with one or more episodes).

Comparison 7 Dressing systems (any), Outcome 2 Exit site/tunnel infection rate (episodes/total patient‐months on PD).
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Analysis 7.2

Comparison 7 Dressing systems (any), Outcome 2 Exit site/tunnel infection rate (episodes/total patient‐months on PD).

Comparison 8 Silver ring system on catheter versus none, Outcome 1 Peritonitis (number of patients with one or more episodes).
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Analysis 8.1

Comparison 8 Silver ring system on catheter versus none, Outcome 1 Peritonitis (number of patients with one or more episodes).

Comparison 8 Silver ring system on catheter versus none, Outcome 2 Exit site/tunnel infection (number of patients with one or more episodes).
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Analysis 8.2

Comparison 8 Silver ring system on catheter versus none, Outcome 2 Exit site/tunnel infection (number of patients with one or more episodes).

Comparison 8 Silver ring system on catheter versus none, Outcome 3 Catheter removal or replacement (number of patients).
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Analysis 8.3

Comparison 8 Silver ring system on catheter versus none, Outcome 3 Catheter removal or replacement (number of patients).

Comparison 8 Silver ring system on catheter versus none, Outcome 4 Mortality (all‐cause).
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Analysis 8.4

Comparison 8 Silver ring system on catheter versus none, Outcome 4 Mortality (all‐cause).

Comparison 9 Antistaphylococcal vaccine (Staphypan) versus placebo, Outcome 1 Peritonitis rate (episodes/total patient‐months on PD).
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Analysis 9.1

Comparison 9 Antistaphylococcal vaccine (Staphypan) versus placebo, Outcome 1 Peritonitis rate (episodes/total patient‐months on PD).

Comparison 9 Antistaphylococcal vaccine (Staphypan) versus placebo, Outcome 2 Exit site/tunnel infection rate (episodes/total patient‐months on PD).
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Analysis 9.2

Comparison 9 Antistaphylococcal vaccine (Staphypan) versus placebo, Outcome 2 Exit site/tunnel infection rate (episodes/total patient‐months on PD).

Comparison 10 Antifungal versus placebo/no treatment, Outcome 1 Fungal peritonitis (number of patients with one or more episodes).
Figures and Tables -
Analysis 10.1

Comparison 10 Antifungal versus placebo/no treatment, Outcome 1 Fungal peritonitis (number of patients with one or more episodes).

Comparison 10 Antifungal versus placebo/no treatment, Outcome 2 Fungal peritonitis rate (episodes/total patient‐months on PD).
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Analysis 10.2

Comparison 10 Antifungal versus placebo/no treatment, Outcome 2 Fungal peritonitis rate (episodes/total patient‐months on PD).

Summary of findings for the main comparison. Oral or topical or intraperitoneal antibiotics versus placebo/no treatment for preventing peritonitis in peritoneal dialysis patients

Oral or topical or intraperitoneal antibiotics versus placebo/no treatment for preventing peritonitis in peritoneal dialysis patients

Patient or population: patients with CKD on peritoneal dialysis
Settings: tertiary settings
Intervention: oral or topical or intraperitoneal antibiotics versus placebo/no treatment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Oral or topical or intraperitoneal antibiotics versus placebo/no treatment

Peritonitis (number of patients with one or more episodes)

Study population

RR 0.82
(0.57 to 1.19)

395 (5)

⊕⊕⊝⊝
low1,2

360 per 1000

295 per 1000
(205 to 428)

Moderate

385 per 1000

316 per 1000
(219 to 458)

Exit‐site/tunnel infection (number of patients with one or more episodes)

Study population

RR 0.45
(0.19 to 1.04)

191 (3)

⊕⊕⊝⊝
low2

176 per 1000

79 per 1000
(34 to 184)

Moderate

231 per 1000

104 per 1000
(44 to 240)

Catheter removal or replacement (number of patients)

Study population

RR 0.82
(0.46 to 1.46)

395 (5)

⊕⊕⊝⊝
low1,2

115 per 1000

94 per 1000
(53 to 168)

Moderate

156 per 1000

128 per 1000
(72 to 228)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Unclear or high risk of bias in 3 of 5 studies
2 Wide confidence intervals due to small patient numbers

Abbreviations: CKD ‐ chronic kidney disease; GRADE ‐ Grading of Recommendations Assessment, Development and Evaluation

Figures and Tables -
Summary of findings for the main comparison. Oral or topical or intraperitoneal antibiotics versus placebo/no treatment for preventing peritonitis in peritoneal dialysis patients
Summary of findings 2. Nasal antibiotics versus placebo/no treatment for preventing peritonitis in peritoneal dialysis patients

Nasal antibiotics versus no treatment for preventing peritonitis in peritoneal dialysis patients

Patient or population: patients with CKD on peritoneal dialysis
Settings: tertiary settings
Intervention: nasal antibiotics versus placebo/no treatment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Nasal antibiotics versus placebo/no treatment

Peritonitis (number of patients with one or more episodes)

Study population

RR 0.94
(0.67 to 1.31)

338 (3)

⊕⊕⊝⊝
low¹,²

294 per 1000

276 per 1000
(197 to 385)

Moderate

331 per 1000

311 per 1000
(222 to 434)

Exit‐site/ tunnel infection (number of patients with one or more episodes)

Study population

RR 1.34
(0.62 to 2.87)

338 (3)

⊕⊕⊝⊝
low¹,²

165 per 1000

221 per 1000
(102 to 473)

Moderate

188 per 1000

252 per 1000
(117 to 540)

Catheter removal or replacement (number of patients)

Study population

RR 0.92
(0.48 to 1.78)

289 (2)

⊕⊕⊝⊝
low¹,²

103 per 1000

95 per 1000
(49 to 183)

Moderate

265 per 1000

244 per 1000
(127 to 472)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

¹ Unclear risk of bias for allocation concealment in largest study (Mupirocin Study 1996)
² Wide confidence intervals due to small patient numbers

Abbreviations: CKD ‐ chronic kidney disease; GRADE ‐ Grading of Recommendations Assessment, Development and Evaluation

Figures and Tables -
Summary of findings 2. Nasal antibiotics versus placebo/no treatment for preventing peritonitis in peritoneal dialysis patients
Summary of findings 3. Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant) for preventing peritonitis in peritoneal dialysis patients

Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant) for preventing peritonitis in peritoneal dialysis patients

Patient or population: patients with CKD on peritoneal dialysis
Settings: tertiary settings
Intervention: topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant)

Peritonitis (number of patients with one or more episodes)

Study population

RR 0.83
(0.65 to 1.06)

853 (6)

⊕⊕⊝⊝
low1,2

235 per 1000

195 per 1000
(153 to 250)

Moderate

152 per 1000

126 per 1000
(99 to 161)

Exit‐site/tunnel infection (number of patients with one or more episodes)

Study population

RR 0.97
(0.74 to 1.27)

913 (7)

⊕⊕⊝⊝
low1,2

238 per 1000

230 per 1000
(176 to 302)

Moderate

222 per 1000

215 per 1000
(164 to 282)

Catheter removal or replacement (number of patients)

Study population

RR 0.89
(0.57 to 1.38)

792 (6)

⊕⊕⊝⊝
low1,2

97 per 1000

86 per 1000
(55 to 134)

Moderate

93 per 1000

83 per 1000
(53 to 128)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

1 Unclear allocation in several studies
2 Imprecision due to small number of patients and events in several studies

Abbreviations: CKD ‐ chronic kidney disease; GRADE ‐ Grading of Recommendations Assessment, Development and Evaluation

Figures and Tables -
Summary of findings 3. Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant) for preventing peritonitis in peritoneal dialysis patients
Summary of findings 4. Antifungal versus placebo/no treatment for preventing peritonitis in peritoneal dialysis patients

Antifungal versus placebo/no treatment for preventing fungal peritonitis in peritoneal dialysis patients

Patient or population: patients with CKD on peritoneal dialysis
Settings: tertiary settings
Intervention: antifungal versus placebo/no treatment during antibiotic course

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Antifungal versus placebo/no treatment

Fungal peritonitis (number of patients with one or more episodes)

Study population

RR 0.28
(0.12 to 0.63)

817 (2)

⊕⊕⊝⊝
low1,2

64 per 1000

18 per 1000
(8 to 40)

Moderate

64 per 1000

18 per 1000
(8 to 40)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 High risk of bias in one study (Lo 1996)
2 Imprecision due to small number of events and studies

Abbreviations: CKD ‐ chronic kidney disease; GRADE ‐ Grading of Recommendations Assessment, Development and Evaluation

Figures and Tables -
Summary of findings 4. Antifungal versus placebo/no treatment for preventing peritonitis in peritoneal dialysis patients
Table 1. Guidelines on antimicrobial interventions to prevent peritonitis in PD

Guideline

Country

Year

Recommendation

Kidney‐Disease Outcomes Quality Initiative

United States of America

NA

No guideline

The Renal Association

United Kingdom

April 2008

July 2010

Guideline 3.1 ‐ PD Access: Implantation Protocol

  • Recommended that renal units have clear protocols for peri‐operative catheter care including the use of antibiotic prophylaxis (1A)

Guideline 5.1.4 ‐ PD Infectious Complications: Prevention Strategies

  • Recommended that initial catheter insertion be accompanied by antibiotic prophylaxis (1B)

Guideline 5.1.5 ‐ PD Infectious Complications: Prevention Strategies

  • Recommended that invasive procedures be accompanied by antibiotic prophylaxis and emptying the abdomen of dialysis fluid for a period commensurate with the procedure (1C)

Guideline 5.1.6 ‐ PD Infectious Complications: Prevention Strategies

  • Recommended that topical antibiotic administration be used to reduce the frequency of S. aureus and Gram‐negative exit‐site infection and peritonitis (1A)

Canadian Society of Nephrology

Canada

NA

No guideline

European Renal Best Practice

Europe

NA

No guideline

International Society for Peritoneal Dialysis

NA

July 2010

November 2011

Guideline 3.1: Implantation Protocol (1A)

  • Recommended that renal units have clear protocols for perioperative catheter care, including the use of antibiotic prophylaxis

  • Recommended that perioperative catheter care protocol include screening for MRSA and nasal carriage of S. aureus

  • Recommended that prophylactic antibiotics be administered to reduce the risk of catheter‐site infection, peritonitis and wound sepsis and there is RCT evidence for the use of vancomycin

Position Statement: Catheter Placement to Prevent Catheter Infections and the Related Peritonitis Episodes

  • Prophylactic antibiotics administered at the time of insertion decrease the infection risk. A first‐generation cephalosporin or vancomycin can be used, but suggested each program should weigh the potential benefit against the risk of vancomycin use (development of resistant organisms)

  • There is no data on the effectiveness of obtaining nose cultures before catheter insertion, and treating patients positive for S. aureus nasal carriage

Position Statement: Exit‐Site Care to Prevent Peritonitis

  • Antibiotic protocols against S. aureus are effective in reducing the risk of S. aureus catheter infections

  • All PD patients should use topical antibiotic either at the catheter exit‐site or intranasally or both

  • Topical antibiotic ointments (as opposed to antibiotic creams) should not be used at the exit site of polyurethane catheters

Position Statement: Prevention of Fungal Peritonitis

  • Most episodes of fungal peritonitis are preceded by courses of antibiotics

  • Fungal prophylaxis during antibiotic therapy may prevent some cases of Candida peritonitis in programs that have high rates of fungal peritonitis

Kidney Health Australia‐Caring for Australasians with Renal Impairment

Australia/ New Zealand

February 2014

Guideline 6. Prophylactic Antibiotics for Insertion of PD Catheters

  • Recommended that intravenous antibiotic prophylaxis be used prior to peritoneal dialysis catheter insertion to reduce the risk of early peritonitis

  • Vancomycin, cephalosporins and gentamicin have demonstrated effectiveness in reducing the risk of peritonitis

Guideline 8. Treatment of Peritoneal Dialysis‐Associated Fungal Peritonitis

  • Oral antifungal prophylaxis should be considered when antibiotics are administered to patients undergoing peritoneal dialysis to reduce the risk of developing fungal peritonitis

  • Prophylactic antifungals should be administered before gynaecological procedures

Guideline 10. Prophylaxis for Exit‐site/Tunnel Infections Using Mupirocin

  • Recommended that prophylactic therapy using mupirocin ointment be used, especially for S. aureus carriage (intranasally or at the exit site) to decrease the risk of S. aureus catheter exit‐site/tunnel infections and peritonitis

  • Suggested that clean the PD catheter exit site daily and apply a topical antimicrobial agent (either mupirocin or gentamicin)

MRSA ‐ methicillin‐resistant S. aureus; NA ‐ not applicable; PD ‐ peritoneal dialysis

Figures and Tables -
Table 1. Guidelines on antimicrobial interventions to prevent peritonitis in PD
Table 2. Comparisons in original review and updated review

Comparisons in 2004 review

Comparisons in 2017 review

Oral antibiotics versus none

Oral or topical antibiotics versus placebo/no treatment

Nasal antibiotics versus none

Oral or topical antibiotics versus other antibiotic

Peri‐operative IV prophylaxis versus none

Nasal antibiotics versus no treatment

Peri‐operative IV prophylaxis head‐to‐head

Pre/peri‐operative IV prophylaxis versus none or head‐to‐head

Topical disinfectants versus none

Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant)

Germicidal chamber versus none

Germicidal chamber versus none

Antistaphylococcal vaccine (Staphypan) versus placebo

Dressing systems (any)

Antibiotic prophylaxis head‐to‐head agents

Silver ring system on catheter versus none

‐‐

Antistaphylococcal vaccine (Staphypan) versus placebo

‐‐

Antifungal versus placebo/no treatment

Figures and Tables -
Table 2. Comparisons in original review and updated review
Table 3. Other outcomes analysed

Outcome analysed

Number of studies

Number of patients

RR (95% CI)

Oral antibiotic prophylaxis

Pruritus

1

64

3.00 (0.13 to 71.00)

Diarrhoea

1

64

0.09 (0.01 to 1.58)

Nausea

1

64

9.00 (0.50 to 160.59)

Allergy

1

64

5.00 (0.25 to 100.20)

Nasal antibiotic prophylaxis

Nasal irritation

1

15

2.10 (0.10 to 44.40)

Rhinitis

1

267

0.74 (0.27 to 2.09)

Headache

1

267

0.99 (0.14 to 6.94)

Diarrhoea

1

267

1.65 (0.40 to 6.78)

Nausea

1

267

0.99 (0.14 to 6.94)

Vomiting

1

267

2.98 (0.61 to 14.94)

Pruritus

1

267

1.49 (0.25 to 8.77)

Topical disinfectants

Technique failure

1

149

0.19 (0.01 to 3.83)

Pruritus

1

149

10.29 (0.58 to 182.92)

Figures and Tables -
Table 3. Other outcomes analysed
Comparison 1. Oral or topical antibiotics versus placebo/no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis (number of patients with one or more episodes) Show forest plot

5

395

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.57, 1.19]

1.1 Oral antibiotic versus placebo

4

241

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.58, 1.32]

1.2 Mupirocin ointment versus standard care

1

154

Risk Ratio (M‐H, Random, 95% CI)

0.55 [0.22, 1.40]

2 Peritonitis rate (episodes/total patient‐months on PD) Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Any systemic antibiotic versus placebo/no treatment (excluding nystatin)

3

1440

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.40, 1.14]

3 Exit‐site/tunnel infection (number of patients with one or more episodes) Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Any systemic antibiotic versus placebo/no treatment

3

191

Risk Ratio (M‐H, Random, 95% CI)

0.45 [0.19, 1.04]

4 Exit‐site/tunnel infection rate (episodes/total patient‐months on PD) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Any systemic antibiotic versus placebo/no treatment

2

939

Risk Ratio (M‐H, Random, 95% CI)

0.42 [0.17, 1.05]

5 Catheter removal or replacement (number of patients) Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 Any systemic antibiotic versus placebo/no treatment

5

395

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.46, 1.46]

6 Mortality (all‐cause) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 Any systemic antibiotic versus placebo/no treatment

4

201

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.41, 1.89]

7 Mortality due to peritonitis Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

7.1 Oral antibiotic versus placebo

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Adverse effects Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

8.1 Diarrhoea

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Nausea

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.3 Pruritus (generalised)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.4 Nasal irritation

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.5 Allergy

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Oral or topical antibiotics versus placebo/no treatment
Comparison 2. Oral or topical antibiotics versus other antibiotic

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis (number of patients with one or more episodes) Show forest plot

4

314

Risk Ratio (M‐H, Random, 95% CI)

1.28 [0.89, 1.84]

1.1 Sodium fusidate ointment versus ofloxacin (oral)

1

18

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.03, 1.82]

1.2 Mupirocin ointment versus rifampin (oral)

1

82

Risk Ratio (M‐H, Random, 95% CI)

1.25 [0.67, 2.33]

1.3 Mupirocin ointment/cream versus gentamicin cream (topical)

2

214

Risk Ratio (M‐H, Random, 95% CI)

1.39 [0.93, 2.07]

2 Peritonitis rate (episodes/total patient‐months on PD) Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Mupirocin ointment versus polysporin triple ointment (exit site)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Sodium fusidate ointment versus ofloxacin (oral)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 Mupirocin ointment versus neomycin sulphate ointment (nasal)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.4 Mupirocin ointment versus rifampin (oral)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.5 Mupirocin ointment versus gentamicin cream (exit site)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Exit‐site/tunnel infection (number of patients with one or more episodes) Show forest plot

4

336

Risk Ratio (M‐H, Random, 95% CI)

1.28 [0.71, 2.31]

3.1 Mupirocin ointment versus sodium fusidate ointment (topical)

1

100

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.42, 1.95]

3.2 Sodium fusidate ointment versus ofloxacin (oral)

1

22

Risk Ratio (M‐H, Random, 95% CI)

2.41 [0.76, 7.62]

3.3 Mupirocin ointment/cream versus gentamicin cream (topical)

2

214

Risk Ratio (M‐H, Random, 95% CI)

1.19 [0.41, 3.46]

4 Exit‐site/tunnel infection rate (episodes/total patient‐months on PD) Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4.1 Mupirocin ointment versus polysporin triple ointment (exit site)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Mupirocin ointment versus gentamicin cream (exit site)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.3 Sodium fusidate ointment versus ofloxacin (oral)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Catheter removal or replacement (number of patients) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

5.1 Mupirocin ointment versus polysporin triple ointment (exit site)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Sodium fusidate ointment versus ofloxacin (oral)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.3 Mupirocin ointment (exit site) versus rifampin (oral)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.4 Mupirocin cream versus gentamicin cream (exit site)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Mortality (all‐cause) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

6.1 Mupirocin ointment versus polysporin triple ointment (exit site)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Sodium fusidate ointment versus ofloxacin (oral)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.3 Mupirocin ointment versus rifampin (oral)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.4 Mupirocin ointment versus gentamicin cream (exit site)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

7.1 Mupirocin ointment versus polysporin triple ointment (exit site)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Adverse effects Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

8.1 Nausea

1

82

Risk Ratio (M‐H, Random, 95% CI)

0.09 [0.01, 1.59]

8.2 Pruritus (local)

2

337

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.29, 1.49]

Figures and Tables -
Comparison 2. Oral or topical antibiotics versus other antibiotic
Comparison 3. Nasal antibiotics versus placebo/no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis (number of patients with one or more episodes) Show forest plot

3

338

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.67, 1.31]

2 Peritonitis rate (episodes/total patient‐months on PD) Show forest plot

2

2797

Risk Ratio (M‐H, Random, 95% CI)

0.67 [0.16, 2.77]

3 Exit site and tunnel infection (number of patients with one or more episodes) Show forest plot

3

338

Risk Ratio (M‐H, Random, 95% CI)

1.34 [0.62, 2.87]

4 Exit site and tunnel infection rate (episodes/total patient‐months on PD) Show forest plot

2

2796

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.29, 2.92]

5 Catheter removal or replacement (number of patients) Show forest plot

2

289

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.48, 1.78]

6 Mortality (all‐cause) Show forest plot

3

338

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.53, 1.47]

7 Adverse effects Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

7.1 Headache

1

267

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.14, 6.94]

7.2 Diarrhoea

1

267

Risk Ratio (M‐H, Random, 95% CI)

1.65 [0.40, 6.78]

7.3 Nausea

1

267

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.14, 6.94]

7.4 Vomiting

1

267

Risk Ratio (M‐H, Random, 95% CI)

2.98 [0.61, 14.49]

7.5 Pruritus

1

267

Risk Ratio (M‐H, Random, 95% CI)

1.49 [0.25, 8.77]

7.6 Nasal irritation/rhinitis

2

289

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.30, 2.94]

Figures and Tables -
Comparison 3. Nasal antibiotics versus placebo/no treatment
Comparison 4. Pre/peri‐operative prophylaxis versus placebo/no treatment or other antibiotic

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis (number of patients with one or more episodes) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Vancomycin versus placebo

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Cefazolin versus placebo

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 IV gentamicin versus no antibiotics

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.4 IV cefazolin + gentamicin versus no antibiotics

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.5 IV cefuroxime + cefuroxime (intraperitoneal) versus no antibiotics

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.6 Vancomycin versus cefazolin

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Exit site/tunnel infection (number of patients with one or more episodes) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Vancomycin versus placebo

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Cefazolin versus placebo

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 IV gentamicin versus no antibiotics

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.4 IV cefazolin + gentamicin versus no antibiotics

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.5 IV cefuroxime + cefuroxime (intraperitoneal) versus no antibiotics

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.6 Vancomycin versus cefazolin

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Catheter removal or replacement (number of patients) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Mortality (all‐cause) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 4. Pre/peri‐operative prophylaxis versus placebo/no treatment or other antibiotic
Comparison 5. Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis (number of patients with one or more episodes) Show forest plot

6

853

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.65, 1.06]

1.1 Disinfectant versus standard care

3

393

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.52, 1.26]

1.2 Disinfectant versus other active treatment (antibiotics, other disinfectant)

3

460

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.62, 1.13]

2 Exit site/tunnel infection (number of patients with one or more episodes) Show forest plot

8

973

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.75, 1.33]

2.1 Disinfectant versus standard care

4

453

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.45, 1.20]

2.2 Disinfectant versus other active treatment (antibiotics, other disinfectant)

4

520

Risk Ratio (M‐H, Random, 95% CI)

1.19 [0.89, 1.60]

3 Exit site/tunnel infection rate (episodes/total patient‐months on PD) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Disinfectant versus other active treatment (antibiotics, other disinfectant)

2

1752

Risk Ratio (M‐H, Random, 95% CI)

1.25 [0.31, 4.93]

4 Catheter removal or replacement (number of patients) Show forest plot

7

852

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.57, 1.38]

4.1 Disinfectant versus standard care

2

266

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.34, 1.55]

4.2 Disinfectant versus other active treatment (antibiotics, other disinfectant)

5

586

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.57, 1.69]

5 Mortality (all‐cause) Show forest plot

4

697

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.53, 1.44]

5.1 Disinfectant versus standard care

2

266

Risk Ratio (M‐H, Random, 95% CI)

1.24 [0.54, 2.84]

5.2 Disinfectant versus other active treatment (antibiotics, other disinfectant)

2

431

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.39, 1.35]

6 Technique failure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

7 Pruritus (local) Show forest plot

4

609

Risk Ratio (M‐H, Random, 95% CI)

2.80 [1.21, 6.48]

Figures and Tables -
Comparison 5. Topical disinfectants versus standard care or other active treatment (antibiotic or other disinfectant)
Comparison 6. Germicidal chamber versus none

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis rate (episodes/total patient‐months on PD) Show forest plot

2

1855

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.74, 1.51]

2 Mortality (all‐cause) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 6. Germicidal chamber versus none
Comparison 7. Dressing systems (any)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Exit site/tunnel infection (number of patients with one or more episodes) Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Chlorhexidine gluconate + water versus povidone‐iodine solution

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Sodium hypochlorite solution versus povidone‐iodine solution

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Shower + gauze versus dressing pack + fixomull

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.4 Blisterfilm versus gauze

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Exit site/tunnel infection rate (episodes/total patient‐months on PD) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Shower + gauze versus dressing pack + fixomull

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 7. Dressing systems (any)
Comparison 8. Silver ring system on catheter versus none

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis (number of patients with one or more episodes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit site/tunnel infection (number of patients with one or more episodes) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3 Catheter removal or replacement (number of patients) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4 Mortality (all‐cause) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 8. Silver ring system on catheter versus none
Comparison 9. Antistaphylococcal vaccine (Staphypan) versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Peritonitis rate (episodes/total patient‐months on PD) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Exit site/tunnel infection rate (episodes/total patient‐months on PD) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 9. Antistaphylococcal vaccine (Staphypan) versus placebo
Comparison 10. Antifungal versus placebo/no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fungal peritonitis (number of patients with one or more episodes) Show forest plot

2

817

Risk Ratio (M‐H, Random, 95% CI)

0.28 [0.12, 0.63]

2 Fungal peritonitis rate (episodes/total patient‐months on PD) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figures and Tables -
Comparison 10. Antifungal versus placebo/no treatment