***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The efficacy of cephalothin sodium , added to dialysis fluids , as prophylaxis against infection during peritoneal dialysis was tested in a r and om double-blind study of 95 dialyses performed in 36 patients . Although the two cases of clinical peritonitis observed occurred in the placebo group , this observation was not statistically significant . The number of positive cultures obtained from the dialysate returns , however , was significantly greater in the placebo group . The duration of the dialysis did not correlate with the finding of bacteria in the dialysate returns or with the development of clinical peritonitis Infection is the Achilles heel of peritoneal dialysis . Exit site mupirocin prevents Staphylococcus aureus peritoneal dialysis ( PD ) infections but does not reduce Pseudomonas aeruginosa or other Gram-negative infections , which are associated with considerable morbidity and sometimes death . Patients from three centers ( 53 % incident to PD and 47 % prevalent ) were r and omized in a double-blinded manner to daily mupirocin or gentamicin cream to the catheter exit site . Infections were tracked prospect ively by organism and expressed as episodes per dialysis-year at risk . A total of 133 patients were r and omized , 67 to gentamicin and 66 to mupirocin cream .  Catheter infection rates were 0.23/yr with gentamicin cream versus 0.54/yr with mupirocin ( P = 0.005 ) . Time to first catheter infection was longer using gentamicin ( P = 0.03 ) . There were no P. aeruginosa catheter infections using gentamicin compared with 0.11/yr using mupirocin ( P < 0.003 ) . S. aureus exit site infections were infrequent in both groups ( 0.06 and 0.08/yr ; P = 0.44 ) . Peritonitis rates were 0.34/yr versus 0.52/yr ( P = 0.03 ) , with a striking decrease in Gram-negative peritonitis ( 0.02/yr versus 0.15/yr ; P = 0.003 ) using gentamicin compared with mupirocin cream , respectively . Gentamicin use was a significant predictor of lower peritonitis rates ( relative risk , 0.52 ; 95 % confidence interval , 0.29 to 0.93 ; P < 0.03 ) , controlling for center and incident versus prevalent patients . Gentamicin cream applied daily to the peritoneal catheter exit site reduced P. aeruginosa and other Gram-negative catheter infections and reduced peritonitis by 35 % , particularly Gram-negative organisms . Gentamicin cream was as effective as mupirocin in preventing S. aureus infections . Daily gentamicin cream at the exit site should be the prophylaxis of choice for PD patients We have studied the efficacy of topical Mupirocin for elimination of Staphylococcus aureus ( Staph . aureus ) nasal carriage in CAPD patients . Staph . aureus nasal carriers in our CAPD program were r and omized to one of two groups : Group 1 , treated with Mupirocin , and Group 2 , treated with neomycin sulphate nasal ointment . The prevalence of Staph . aureus nasal colonization was 44 % for patients ( 24/54 ) and 17 % for dialysis partners ( 5/29 ) . Group 1 included 11 patients and 1 partner , and Group 2 , 8 patients and 2 partners . In Group 1 , the eradication rate was 100 % , and the recolonization rate was 0 , 8 , 41 , 55 and 66 % at 1 , 2 , 3 , 6 and 10 months . In Group 2 , the eradication rate was 40 % , with a recolonization rate of 0.25 and 75 % at 1 , 2 and 3 months . Re-treatment with mupirocin  was successful in 66 % of the cases , compared to 20 % for neomycin . The MIC90 of mupirocin  for Staph . aureus was 0.5 mcg/mL , with an increase to 4 mcg/mL towards the end of the study . During the study period , there was a very low incidence of Staph . aureus peritonitis or catheter-related infections in patients treated with mupirocin .  Secondary effects of mupirocin were negligible . Mupirocin is more effective than neomycin sulphate for the elimination of Staph . aureus nasal colonization in patients undergoing CAPD . Periodic re-treatment is frequently necessary , given the significant recolonization rate This study evaluates the dialysis-related infection rate in children receiving peritoneal dialysis with Staphylococcus aureus nasal carriage . Children with S. aureus nasal carriage were r and omized to treatment with rifampin and bacitracin or no treatment . The children were observed for one month after r and omization for evidence of a S. aureus dialysis-related infection . Individuals with nasal carriage had a higher incidence of S. aureus dialysis-related infection than those patients without carriage ( p < 0.05 ) . Those children treated for nasal carriage had a lower dialysis-related infection rate than those who were untreated ( p < 0.05 ) . We conclude that children receiving peritoneal dialysis with nasal carriage of S. aureus are at a greater risk of developing a S. aureus dialysis-related infection . The treatment of nasal carriage in this population decreased the risk of a S. aureus dialysis-related infection ♦ Background : The HONEYPOT study is a multicenter , open-label , blinded- outcome , r and omized controlled trial design ed to determine whether , compared with st and ard topical application of mupirocin for nasal staphylococcal carriage , exit-site application of antibacterial honey reduces the rate of catheter-associated infections in peritoneal dialysis patients . ♦ Objective : To make public the pre-specified statistical analysis principles to be adhered to and the procedures to be performed by statisticians who will analyze the data for the HONEYPOT trial . ♦ Methods : Statisticians and clinical investigators who were blinded to treatment allocation and treatment-related study results and who will remain blinded until the central data base is locked for final data extraction and analysis determined the statistical methods and procedures to be used for analysis and wrote the statistical analysis plan . The plan describes basic analysis principles , methods for dealing with a range of commonly encountered data analysis issues , and the specific statistical procedures for analyzing the primary , secondary , and safety outcomes . ♦ Results : A statistical analysis plan containing the pre-specified principles , methods , and procedures to be adhered to in the analysis of the data from the HONEYPOT trial was developed in accordance with international guidelines . The structure and content of the plan provide sufficient detail to meet the guidelines on statistical principles for clinical trials produced by the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use . ♦ Conclusions : Making public the pre-specified statistical analysis plan for the HONEYPOT trial minimizes the potential for bias in the analysis of trial data and the interpretation and reporting of trial results Exit site infection is a major risk factor for the development of peritonitis in continuous ambulatory peritoneal dialysis . The frequency of infection can be reduced by scrupulous exit site care with or without topical antiseptics . A r and omized trial was performed of 149 catheters in 130 patients to assess any additional benefits conferred by the use of povidine iodine dry powder spray at dressing changes over an existing strict protocol of exit care . Exit infections occurred in 14 ( 18 % ) of 77 patients using spray and in 15 ( 21 % ) of 72 patients not using spray . The risk of peritonitis was also similar in each group . The proportion of infections caused by Staphylococcus aureus was reduced in the spray group , but those caused by Pseudomonas aeruginosa were increased . Rash occurred in 6 % of those using the spray . The use of the spray did not therefore seem justified Over a three-year period , 217 episodes of bacterial peritonitis occurred in 183 patient years . Thirty-seven episodes were due to Staphylococcus aureus and 19 ( 51 % ) of these required removal of the catheter to eradicate infection . This compared with catheter loss in 4/63 ( 6.3 % ) coagulase negative staphylococci infections ( p < 0.001 ) ; 7/67 ( 9.5 % ) culture negative peritonitis ( p < 0.001 ) ; and 10/30 ( 33.3 % ) episodes due to gram-negative organisms ( p < 0.05 ) . Over half ( 51.3 % ) the episodes due to S. aureus were associated with exit-site infections , and this rose to 100 % ( 10/10 ) with recurrent peritonitis ( p < 0.01 ) . A prospect i ve analysis of nasal carriage and exit-site infections due to S. aureus was carried out in 87 patients .  Exit-site infections were present in 21 ( 24 % ) , almost entirely due to different strains as judged by sensitivity patterns and phage typing . Nasal carriage , defined as two positive swabs within the study period , was present in 20 ( 23 % ) patients . Fourteen ( 70 % ) of these had exit site infections due to the same strain as that isolated from the nose , whereas no patient grew different strains from either site . Nasal carriage increased the risk of infection sixfold ( p < 0.001 ) Background The use of  peritoneal dialysis ( PD )  has declined in the United States over the past decade and technique failure is also reportedly higher in PD compared to hemodialysis ( HD ) , but there are little data in the United States addressing the factors and outcomes associated with switching modalities from PD to HD . Methods In a prospect i ve cohort study of 262 PD patients enrolled from 28 peritoneal dialysis clinics in 13 U.S. states , we examined potential predictors of switching from PD to HD ( including demographics , clinical factors , and laboratory values ) and the association of switching with mortality . Cox proportional hazards regression was used to assess relative hazards ( RH ) of switching and of mortality in PD patients who switched  to HD . Results Among 262 PD patients , 24.8 % switched to HD ; with more than 70 % switching within the first 2 years . Infectious peritonitis was the leading cause of switching . Patients of black race and with higher body mass index were significantly more likely to switch from  PD to HD  , RH ( 95 % CI ) of 5.01 ( 1.15–21.8 ) for black versus white and 1.09 ( 1.03–1.16 ) per 1 kg/m2 increase in BMI , respectively . There was no difference in survival between switchers and non-switchers , RH ( 95 % CI ) of 0.89 ( 0.41–1.93 ) . ConclusionS witching from PD to HD occurs early and the rate is high , threatening long-term viability of PD programs . Several patient characteristics were associated with the risk of switching . However , there was no survival difference between switchers and non-switchers , reassuring providers and patients that PD technique failure is not necessarily associated with poor prognosis ♦ Background : One of the most common and severe complications affecting peritoneal dialysis ( PD ) patients is exit-site infection of the peritoneal catheter ; it is therefore of vital importance to prevent it . This complication has a negative impact on the success of the technique . In spite of this , there are no clear guidelines concerning how to take care of the exit site . The objective of this study was to assess the efficacy of polyhexanide in preventing exit-site infection over a 12-month period . ♦ Methods : We design ed a single-center , prospect i ve , open-labeled , r and omized controlled clinical trial with parallel groups . Requirements for participation in the study included implantation of the peritoneal catheter at least six weeks before entering the study and no infectious complications requiring either hospital admission or antibiotic treatment for at least three months before entering into the study . Patients were r and omized to be daily cured as follows : Group A : traditional care with saline serum and povidone-iodine ; and Group B : polyhexanide solution . Exit sites were evaluated at baseline and every four to six weeks or if any event occurred , according to the Twardowski criteria . ♦ Results : Of the 60 included patients , 46 completed the 12-month follow-up period . Six underwent transplantation , five died and three were transferred to hemodialysis ( HD ) . The treatment was well tolerated , with no side effects nor ab and onments due to such effects . Throughout the study period , six patients ( 20 % ) undergoing traditional care and only two ( 6,7 % ) receiving polyhexanide developed an exit-site infection ( p = 0.032 ) . There were a total number of 12 infections ; nine occurred in patients following the traditional approach and only three in patients treated with polyhexanide ( p = 0.037 ) . The germs responsible for the infections were : S. aureus ( six cases ) , Corynebacterium jeikeium ( two cases ) and P. aeruginosa ( one case ) in the saline serum and povidone-iodine group and P. aeruginosa ( three cases ) in the polyhexanide group . The mean rate of exit-site infection was 1 episode/36. 
    Output:
    
This review demonstrates that pre/peri-operative intravenous vancomycin may reduce the risk of early peritonitis and that antifungal prophylaxis with oral nystatin or fluconazole reduces the risk of fungal peritonitis following an antibiotic course .
However , no other antimicrobial interventions have proven efficacy .
In particular , the use of nasal antibiotic to eradicate Staphylococcus aureus , had an uncertain effect on the risk of peritonitis and raises questions about the usefulness of this approach .