Abstract

Although, decreasing in incidence with the disconnection systems, the first complication is still peritonitis in patients with chronic renal failure and the second is infection of Tenckhoff catheter exit-site. All efforts made to diminish the frequency of exit-site infection lower the possibility of peritonitis. The pediatric population is well-known to have a major risk of infectious complications, and making easy and safe the care of the exit-site will prevent the peritonitis that follows. The aim of the study was to evaluate the efficacy of the Amuchina 10% solution vs. pH neutral soap in children with chronic renal failure, on preventing exit-site infection. There were 60 patients who were assigned randomly to one of two groups. One group used Amuchina 10% solution for the daily cleaning of the exit-site, and the other used pH neutral soap, with 14 months of follow-up. Before the study they have to be free of infection for at least 30 days. All were taught by the same nurse how to clean their exit-site. Groups were almost identical in years, sex, and time on dialysis. We had nine infections in the soap group and none in the Amuchina 10% solution group, with an OR: 17 (p = 0.004). From these nine infections, the bacteria isolated were: 4 (13%) were caused by Pseudomona aeruginosa, 1 (3.3%) by Staphylococcus aureus, coagulase-positive staphylococci in 2 (6.6%) and Serratia marcensens in 1 (3.3%). In conclusion, Amuchina 10% solution is effective in preventing infection on the exit-site, without any secondary topical reaction.

Copyright © 2007 S. Karger AG, Basel

In Mexico, chronic renal failure (CRF) has one of the highest world prevalence rates, with more than 1,000 patients/million inhabitants, although the number of patients treated is low. In our institution 85% of the patients are treated with peritoneal dialysis (PD), with a prevalence of 200-300 patients/ million inhabitants i.e. one of every five patients is treated. Kidney failure in children in the Mexican Social Security is approximately 8% of these patients [1].

The need of a Tenckhoff catheter installation causes in itself risk complications in patients with a poor social condition.

Peritonitis and exit-site infection remain the most important limitations to the delivery of PD. The exit-site infection is an unsolved difficulty, in which Staphylococci is a main problem [2-5].

A more recent problem is the appearance of Staphylococcus aureus isolated with a high degree of resistance to the topical antimicrobial agent mupirocin. This was documented in PD patients who have received prophylactic application of mupirocin at the peritoneal catheter exit-site [6].

It is currently believed that Amuchina is an effective antiseptic for prevention of Tenckhoff catheter exit-site infection. As an electrolytic chloroxidizer with a pH of 9.5-10.5, stable sodium hypochlorite base, absence of caustic alkalinity, fulfills the principal characteristics for a quick and powerful antiseptic action, mild on skin and other tissues.

There are few studies of Amuchina for preventing the exit-site infection; but Cabralda's studies in transfer-set change in PD showed good cost effective results [7].

Although there is still controversy over whether they are the best strategies for preventing exit-site infection, in emerging countries the best strategies are prevention, early detection and we cannot afford bacterial resistance. So Amuchina had proved good results in our poor nourished, with poor living conditions children with a very easy and safe way of spray application, but more studies had to be done.

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