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John Conly - One of the best experts on this subject based on the ideXlab platform.

  • a double blind randomized controlled trial of topical Polysporin triple compound versus topical mupirocin for the eradication of colonization with methicillin resistant staphylococcus aureus in a complex continuing care population
    Canadian Journal of Infectious Diseases & Medical Microbiology, 2009
    Co-Authors: S Ogrady, Z Hirji, B Pejcickarapetrovic, S Fung, H Dedier, J Takatashewchuk, K Zhang, John Conly
    Abstract:

    BACKGROUND: Intranasal mupirocin or Polysporin Triple (PT) ointment (polymyxin B, bacitracin, gramicidin), in combination with chlorhexidine body washes, have been used for eradicating methicillin-resistant Staphylococcus aureus (MRSA), but no comparative studies have been done.

  • hemodialysis infection prevention with Polysporin ointment
    Journal of The American Society of Nephrology, 2003
    Co-Authors: Charmaine E Lok, Kenneth Stanley, Janet E Hux, Robert M Richardson, Sheldon W Tobe, John Conly
    Abstract:

    Hemodialysis patients in whom permanent vascular access cannot be achieved are dependent on a central venous catheter. In such patients, catheter-related infections are a common and serious complication. This study was a randomized clinical trial to determine if topical Polysporin Triple antibiotic ointment applied to the central venous catheter insertion site could reduce the incidence of catheter-related infections. A total of 169 patients receiving hemodialysis through a central venous catheter were randomized to receive Polysporin Triple or placebo using a double-blind study design. In the 6-mo study period, infections were observed in more patients in the placebo group than in the Polysporin Triple group (34 versus 12%; relative risk, 0.35; 95% CI, 0.18 to 0.68; P = 0.0013). The number of infections per 1000 catheter days (4.10 versus 1.02; P < 0.0001) and the number of bacteremias per 1000 catheter days (2.48 versus 0.63; P = 0.0004) were also greater in the placebo group. Within the 6-mo study period, there were 13 deaths in the placebo group as compared with 3 deaths in the Polysporin Triple group (P = 0.0041). When all available follow-up information was included, the difference in survival remained significant (19 versus 9 deaths; P = 0.0027). Within the first 6 mo, infections were observed in 7 of the 13 placebo subjects who died (54%) as compared with no infections in the three Polysporin Triple subjects who died. The prophylactic application of topical Polysporin Triple antibiotic ointment to the central venous catheter insertion site reduced the rate of infections and was associated with improved survival in hemodialysis patients.

  • the utility of Polysporin ointment in the eradication of methicillin resistant staphylococcus aureus colonization a pilot study
    Infection Control and Hospital Epidemiology, 2000
    Co-Authors: S Fung, S Ogrady, H Dedier, Catharine Kennedy, Iivi Campbell, John Conly
    Abstract:

    We evaluated the efficacy of an ointment containing bacitracin, polymyxin B, and gramicidin for the eradication of colonization by methicillin-resistant Staphylococcus aureus in 11 medical patients, 10 (91%) of whom had previously failed a 1-week course of topical mupirocin. Mupirocin resistance was documented in 5 (45%) of 11 patients. Successful decolonization was achieved in 9 (82%) of 11 patients (based on 2 months of follow-up).

Charmaine E Lok - One of the best experts on this subject based on the ideXlab platform.

  • hemodialysis infection prevention using Polysporin ointment with shower technique in satellite units hippo sat pilot study design
    Nephrology - Open Journal, 2015
    Co-Authors: Sarah Daisy Kosa, Paul Tam, Amiram Gafni, Andrew A House, Julieann Lawrence, Louise Moist, Bharat Nathoo, Alicia Sarabia, Lehana Thabane, Charmaine E Lok
    Abstract:

    Background: Hemodialysis patients are often advised not to shower if they have a central ve- nous catheter (catheter). We developed a shower technique catheter protocol for hemodialysis patients with healed catheter exit sites, designed to permit showering but not increase catheter- related infection risk. Research question: Is it feasible to conduct a randomized control trial comparing the rate of catheter related bacteremia in adult satellite hemodialysis patients using the shower technique protocol versus standard catheter care alone with 6 month follow up? Study Design: This pilot study is a multi-centre randomized control trial. Eligible participants will be randomized to shower technique protocol versus standard care after meeting predefined criteria to confirm healed tunneled catheter exit site. Primary Outcome: Feasibility will be determined by 5 outcome measures: 1) accuracy of the catheter related bacteremia rate documentation in the satellite hemodialysis centre setting, per- centage of patients 2) screened, 3) recruited, 4) educated successfully in the shower technique protocol (intervention arm), and 5) treatment contamination of study groups. Study Setting: In 2 academic and 3 community based satellite hemodialysis centres in south central Ontario, Canada. Patient Population: Adult satellite hemodialysis patients dialyzing via tunneled central venous catheters with healed catheter exit sites. Intervention: Shower technique protocol and standard catheter care or control (standard cath- eter care only). Analysis: Each measure of feasibility has its own statistical threshold for success. If the thresh- old is reached in 4 of the 5 measures, the full study will be deemed feasible. Discussion: A pilot feasibility study of the larger study is critical due to the potential challenges associated with recruitment, compliance and participant ascertainment bias.

  • a randomized controlled trial comparing mupirocin and Polysporin triple ointments in peritoneal dialysis patients the mp3 study
    Clinical Journal of The American Society of Nephrology, 2012
    Co-Authors: Rory F Mcquillan, Charmaine E Lok, Ernest Chiu, Sharon J Nessim, Janet Roscoe, Paul Tam, Sarbjit V Jassal
    Abstract:

    Summary Background and objectives Infectious complications remain a significant cause of peritoneal dialysis (PD) technique failure. Topical ointments seem to reduce peritonitis; however, concerns over resistance have led to a quest for alternative agents. This study examined the effectiveness of applying topical Polysporin Triple ointment (P 3 ) against mupirocin in a multi-centered, double-blind, randomized controlled trial. Design, setting, participants, & measurements PD patients routinely applied either P 3 or mupirocin ointment to their exit site. Patients were followed for 18 months or until death or catheter removal. The primary study outcome was a composite endpoint of exit-site infection (ESI), tunnel infection, or peritonitis. Results Seventy-five of 201 randomized patients experienced a primary outcome event (51 peritonitis episodes, 24 ESIs). No difference was seen in the time to first event for P 3 (13.2 months; 95% confidence interval, 11.9–14.5) and mupirocin (14.0 months; 95% confidence interval, 12.7–15.4) ( P =0.41). Twice as many patients reported redness at the exit site in the P 3 group (14 versus 6, P =0.10). Over the complete study period, a higher rate per year of fungal ESIs was seen in patients using P 3 (0.07 versus 0.01; P =0.02) with a corresponding increase in fungal peritonitis (0.04 versus 0.00, respectively; P Conclusions This study shows that P 3 is not superior to mupirocin in the prophylaxis of PD-related infections. Colonization of the exit site with fungal organisms is of concern and warrants further study. As such, the use of P 3 over mupirocin is not advocated in the prophylaxis of PD-related infections.

  • long term follow up of the hemodialysis infection prevention with Polysporin ointment hippo study a quality improvement report
    American Journal of Kidney Diseases, 2011
    Co-Authors: M Battistella, Charmaine E Lok, Cynthia Bhola
    Abstract:

    Background Infection is a common and serious complication in hemodialysis patients accessed using central venous catheters (CVCs). Previously, a randomized double-blinded trial (HIPPO [Hemodialysis Infection Prevention With Polysporin Ointment] Study) showed that application of a topical polyantibiotic ointment at the CVC exit site decreased CVC-related infections, including bacteremias and their adverse consequences. Based on this study's results, our institution implemented a policy of routine topical polyantibiotic ointment application for CVC-related infection prophylaxis. The main purpose of this prospective observational study was to determine whether the low rate of CVC-related infection achieved by topical polyantibiotic ointment use during a randomized controlled trial would be observed during long-term prophylaxis as part of routine clinical care. Study Design Quality improvement report. Setting & Participants All adult long-term hemodialysis patients using a tunneled cuffed CVC in a large university-affiliated outpatient hemodialysis program in 2004-2009 were included. Quality Improvement Plan To prospectively monitor the impact of a policy-wide strategy of topical polyantibiotic ointment application at CVC exit sites (1 time/wk) as infection prophylaxis. A multidisciplinary team approach to the surveillance, prospective tracking, and management of hemodialysis CVC-related infection was used. Outcomes & Measurements Rates of CVC-related infections (exit-site infections and bacteremias), percentages of contributing organisms, and consequences of CVC-related infections. Results After 6 years, CVC exit-site infection and bacteremia rates remained low ( Limitations A center effect of the same institution conducting the randomized trial and the quality improvement study may limit the study's generalizability to other centers. The impact of possible unmeasured cointerventions cannot be excluded. Conclusion Long-term use of topical antibiotic application at CVC exit sites resulted in a sustained decrease in all CVC-related infections. A multidisciplinary effort to monitor and track outcomes allowed safe and effective implementation of a new prophylactic strategy.

  • a randomized controlled trial comparing mupirocin versus Polysporin triplea for the prevention of catheter related infections in peritoneal dialysis patients the mp3 study
    Peritoneal Dialysis International, 2008
    Co-Authors: Sarbjit V Jassal, Charmaine E Lok
    Abstract:

    • Background: Peritonitis remains the most serious complication of peritoneal dialysis (PD). Gram-positive organisms are among the most common causes of PD peritonitis; however, recent trends show increasing rates of gram-negative and fungal infections. Strategies to prevent peritonitis include the use of prophylactic topical mupirodn at the site where the PD catheter exits from the abdominal wall; however, mupirocin does not afford protection against gram-negative or fungal infections. The aim of this study is to determine if the incidence of catheter-related infections (exit-site infection, tunnel infection, or peritonitis) is significantly reduced by the routine application of Polysporin Triple antibiotic ointment (Pfizer Canada, Markham, Ontario, Canada) in comparison to mupirodn ointment. • Methods and Design: The Mupirodn Versus Polysporin Triple Study (MP3) is a multicenter, randomized, double-blinded controlled study comparing Polysporin Triple (P3) against the current standard of care. The aim of the study is to recruit 200 patients being treated with or starting on PD and randomize them to receive either mupirodn or P3 at the catheter exit site. Patients will be followed for 18 months or until death or transfer from PD to an alternate treatment modality. The primary outcome will be the time to first catheter-related infection. Catheter-related infections will be strictly defined using current guidelines and categorized into exit-site infections, infective peritonitis, or tunnel infections. The primary analysis will be an intention-to-treat analysis. • Discussion: The results of this study will help determine if the use of P3 is superior to mupirocin ointment in the prevention of catheter-related infections and will help guide evidence-based best practices.

  • hemodialysis infection prevention with Polysporin ointment
    Journal of The American Society of Nephrology, 2003
    Co-Authors: Charmaine E Lok, Kenneth Stanley, Janet E Hux, Robert M Richardson, Sheldon W Tobe, John Conly
    Abstract:

    Hemodialysis patients in whom permanent vascular access cannot be achieved are dependent on a central venous catheter. In such patients, catheter-related infections are a common and serious complication. This study was a randomized clinical trial to determine if topical Polysporin Triple antibiotic ointment applied to the central venous catheter insertion site could reduce the incidence of catheter-related infections. A total of 169 patients receiving hemodialysis through a central venous catheter were randomized to receive Polysporin Triple or placebo using a double-blind study design. In the 6-mo study period, infections were observed in more patients in the placebo group than in the Polysporin Triple group (34 versus 12%; relative risk, 0.35; 95% CI, 0.18 to 0.68; P = 0.0013). The number of infections per 1000 catheter days (4.10 versus 1.02; P < 0.0001) and the number of bacteremias per 1000 catheter days (2.48 versus 0.63; P = 0.0004) were also greater in the placebo group. Within the 6-mo study period, there were 13 deaths in the placebo group as compared with 3 deaths in the Polysporin Triple group (P = 0.0041). When all available follow-up information was included, the difference in survival remained significant (19 versus 9 deaths; P = 0.0027). Within the first 6 mo, infections were observed in 7 of the 13 placebo subjects who died (54%) as compared with no infections in the three Polysporin Triple subjects who died. The prophylactic application of topical Polysporin Triple antibiotic ointment to the central venous catheter insertion site reduced the rate of infections and was associated with improved survival in hemodialysis patients.

S Fung - One of the best experts on this subject based on the ideXlab platform.

S Ogrady - One of the best experts on this subject based on the ideXlab platform.

H Dedier - One of the best experts on this subject based on the ideXlab platform.