***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 
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    ***EXAMPLES*** 
    Input: 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 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 A prospect i ve r and omized study of the prevention of c and ida peritonitis ( CP ) in continuous ambulatory peritoneal dialysis patients using oral nystatin given concomitantly with antibiotic therapy  was carried out for 2 years . Patients were r and omized into two groups . Nystatin tablets 500,000 units four times a day were given to group 1 but not group 2 patients whenever antibiotics were prescribed . There were 199 patients at risk ( mean follow-up , 18.0 months ) in group 1 and 198 patients at risk ( mean follow-up , 16.6 months ) in group 2 . The peritonitis and antibiotic prescription rates were comparable between the two groups . There were four episodes of CP in four patients in group 1 and 12 episodes in 11 patients in group 2 . The probability of CP-free survival at 2 years was higher in group 1 compared with group 2 ( 0.974 v 0.915 ; P < 0.05 ) . However , only three ( 75 % ) CP episodes in group 1 and six ( 50 % ) in group 2 were considered " antibiotics related . " The incidence of antibiotics-related CP was 1.39 and 3.19 per 100 peritonitis episodes and 0.66 and 1.43 per 100 antibiotic prescriptions in groups 1 and 2 , respectively ( P = NS ) . We conclude that oral nystatin prophylaxis with each antibiotic prescription reduced the rate of CP in patients on continuous ambulatory peritoneal dialysis irrespective of its apparent temporal relationship to antibiotic prescription Staphylococcal infections are a major cause of catheter infections and peritonitis in peritoneal dialysis patients . Since catheter-related infections are associated with nasal carriage of Staphylococcus aureus in this population , we studied the effect of intermittent rifampin , an antibiotic known to decrease S aureus nasal carriage , on catheter-related infections and peritonitis . We r and omly assigned 64 patients to receive either rifampin 300 mg twice daily for 5 days every 3 months or no treatment . The rifampin-treated patients had a significant delay in time to first catheter-related infection ( P less than 0.015 ) and significantly fewer catheter-related infections overall ( P less than 0.001 ) . The catheter-related infection rate in rifampin-treated patients was .26 per patient-year versus .93 per patient-year in untreated patients . Multivariate analysis defined baseline colonization of nares or catheter exit-site and prior renal transplant as risk factors for catheter-related infections . There was no significant difference in peritonitis rates between groups , although the trend was for a delayed time to first episodes and fewer episodes in rifampin-treated patients . Adverse effects necessitated withdrawal of rifampin in four patients . We conclude that intermittent rifampin administration is effective in decreasing catheter-related infections in a peritoneal dialysis population BACKGROUND When a peritoneal dialysis catheter is inserted intra-abdominally in a patient starting peritoneal dialysis ( PD )  there is always a risk for postoperative wound infection and peritonitis . At our centre , PD is started immediately after the dialysis catheter is inserted . This may increase the postoperative risk for peritonitis and wound infection . The aim of this prospect i ve , r and omized , study was to evaluate whether the incidence of microbial growth postoperatively ( within 10 days ) after catheter insertion could be reduced by prophylactic antibiotic therapy . SUBJECTS AND METHODS During a period of 27 months , 38 patients , who consecutively entered the PD programme , ( 11 women and 27 men , mean age 57 years ) were included in the study . Eighteen patients were given cefuroxime 1.5 g i.v . preoperatively and 250 mg i.p . in the first dialysis bag ( containing 1 litre fluid ) as prophylaxis . Twenty patients were not given prophylactic antibiotics ( control group ) . All catheter insertions were performed in an operating theatre by the same surgeons using the same technique . RESULTS In the test group , none of the patients showed microbial growth in the dialysis fluid during the post-operative period , while in the control group six of 20 patients ( 30 % ) suffered from such growth ( P = 0.021 ) . CONCLUSION Prophylactic treatment by cefuroxime i.v . pre- and i.p . perioperatively may reduce the risk for microbial growth and peritonitis after insertion of a Tenckhoff catheter A total of 127 patients from 8 hospitals were r and omized into 1 of 2 exit-site care regimes to evaluate their effect on rate of exit-site infection ( ESI ) . Group 1 used povidone iodine and nonocclusive dressings changed 2 to 3 times weekly ; Group 2 simply cleansed the exit site with nondisinfectant soap and water . Incidence , cause , duration , and treatment of ESI and peritonitis ( P ) were noted . Groups were analysed for age , sex , end-stage renal disease ( ESRD ) , catheter , and systems . Total cumulative follow up time was 95.6 years . There was a significantly higher rate ( p = 0.0183 ) of ESI in Group 2 ( soap and water ) . The mean rate of ESI was 0.27 episodes/patient year for Group 1 versus 0.71 episodes/patient year for Group 2 . Rates of P for the two groups were not significantly different ( p greater than 0.50 ) : 0.446 episodes/year for Group 1 versus 0.574 episodes/year for Group 2 . S. aureus was responsible for 83 % of ESI in Group 1 and 67 % of ESI in Group 2 . Protective dressing with a disinfectant is associated with significantly less ESI than minimum care . However , further research in exit-site care aim ed specifically at reducing S. aureus infection is still required The enrollment of Mexican continuous ambulatory peritoneal dialysis ( CAPD ) patients in a r and omized controlled study began in June 1998 ( 1 ) . A prescription of 4 × 2 L exchanges was compared to an increased dose , achieved by increasing the exchange volume and /or adding an extra nighttime exchange by use of a device . The study included incident and prevalent patients that were between 18 and 70 years of age and had a peritoneal clearance of less than 60 L/ week/1.73 m2 . Patients that were on immunosuppression , had active malignancies , abdominal hernias , cardiac failure , or were positive for hepatitis B or HIV were excluded . Almost 1000 patients were enrolled , 484 to the control group and 481 to the intervention group . The clinical characteristics of the groups were not different . A substantial proportion of the patients in each group were anuric ( 56 % control , 54 % intervention ) . The mean peritoneal Kt/V and creatinine clearances were identical at the start in the two groups but , as planned in the intervention , were well separated for the period of the trial . Total creatinine clearance , averaged across the study duration , was 54.1 versus 62.9 L/week/1.73 m2 ( p < 0.001 ) , and total Kt/V was 1.80 and 2.27 per week ( p < 0.0 
    Output:
    
Staphylococcus Aureus nasal carriage treatment with mupirocin reduces exit-site and tunnel infections but not peritonitis .
Topical gentamicin treatment on the exit site reduces Staphylococcus Aureus infection and peritonitis incidence .
Intravenous antibiotics administration prior to catheter placement significantly reduces the risk of early peritonitis but not exit-site and tunnel infections .
Oral nistatin associated with antibiotic treatment significantly reduces the incidence of C and ida peritonitis .
No other prophylaxis measure seems to be effective based on available evidence .
In patients on peritoneal dialysis current evidence supports the hypothesis that topical mupirocin reduces the risk of Staphylococcus Aureus peritonitis , intravenous antibiotics prior to catheter placement prevent the risk of early peritonitis , and oral nistatin reduces the risk of C and ida peritonitis .