Efficiency of a silver ring in preventing exit-site infections in adult PD patients: results of the SIPROCE Study. Silver ring Prophylaxis of the Catheter Exit Site

Abstract

A randomized, multicenter clinical trial was conducted to evaluate the efficiency in preventing exit-site infection of a silver ring mounted on peritoneal dialysis (PD) catheter and placed at skin level (designed by Grosse-Siestrup, 1992). Eligible patients stratified by diabetes mellitus were monitored prospectively for 12 months using a detailed structured inventory. New patients starting PD treatment during the study period were followed for at least 3 months. Basic characteristics of the silver ring group (N = 86) and controls (N = 88) such as age, sex, S. aureus nasal carriage, type of PD catheter placement and catheter indwelling time, mode of PD, and number of connections for bag exchanges did not differ significantly between the two groups. Nineteen exit-site infections occurred in the silver ring group and 15 in the control group. The incidence of "equivocal" exit-site findings and time of improvement to a "good" or "perfect" exit site were similar in both groups. Kaplan-Meier analysis of the probability of an infection-free time interval revealed no statistically significant difference between subjects with the silver device and controls. In 6 of the 86 cases, displacement of the silver ring caused severe tunnel infection followed by catheter loss in 2. We conclude that the silver ring used in this setting is not effective in preventing exit-site infections in PD patients.