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Intranasal mupirocin does not prevent exit-site infections in children receiving peritoneal dialysis
Yoshinori Araki1, Hiroshi Hataya, Masahiro Ikeda
1Department of Nephrology, Tokyo Metropolitan Kiyose Children's Hospital, Tokyo, Japan. yaraki@jd6.so-net.ne.jp
Insights
Mupirocin nasal ointment did not prevent exit-site infections (ESI) in children undergoing peritoneal dialysis (PD). Further research is needed to find effective ESI prevention methods for pediatric PD patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Pediatrics
Background:
- Exit-site infections (ESI) are a common complication in pediatric peritoneal dialysis (PD) patients.
- Staphylococcus aureus (SA) is the primary pathogen causing ESIs, often originating from nasal carriage.
- ESIs can lead to serious complications like tunnel infections, peritonitis, and PD catheter removal.
Purpose of the Study:
- To evaluate the efficacy of intranasal mupirocin ointment in preventing ESIs in children receiving PD.
- To determine if reducing SA nasal carriage impacts ESI incidence in this population.
Main Methods:
- A single-center study involving 47 pediatric PD outpatients.
- Monthly nasal cultures to identify SA carriers.
- Intervention group received intranasal mupirocin for 7 days.
- Comparison with 77 historical controls.
Main Results:
- 68% of patients were identified as SA nasal carriers.
- SA nasal carriage occurred for 24% of the total study period.
- No significant difference in the incidence of SA-related ESI or peritonitis between the mupirocin group and controls.
- Overall incidence of ESI, peritonitis, and catheter replacement did not differ significantly.
Conclusions:
- Intranasal mupirocin ointment was ineffective in preventing ESIs in pediatric PD patients.
- Current strategies for preventing ESIs in this vulnerable group require further investigation and development.
Objective:
Exit-site infections (ESI) in patients receiving peritoneal dialysis (PD) often progress to tunnel infections and peritonitis, sometimes requiring PD catheter removal. Staphylococcus aureus (SA) is the commonest cause of ESI. In this study, we evaluated the efficacy of mupirocin nasal ointment in preventing ESI in children receiving PD.
Design:
A single-center study.
Setting:
Tokyo Metropolitan Kiyose Children's Hospital.
Patients:
47 outpatients [33 males; age 11.7 +/- 4.9 years (mean +/- SD)] participated in this study between April 1998 and March 1999 at Tokyo Metropolitan Kiyose Children's Hospital. The total study period comprised 399 patient-months. Nasal cultures were performed every month. Nasal carriers of SA applied intranasal mupirocin ointment twice per day for 7 days. We compared the incidence of ESI in the intervention group to 77 historical controls (48 males; age 7.6 +/- 5.1 years); the total control period comprised 2802 patient-months.
Results:
32 patients were identified as SA nasal carriers on one or two occasions (32/47 or 68%). The total period of SA nasal carriage was 95 patient-months (95/399 or 24%). The incidence of ESI caused by SA among all ESI cases was 20/28 (71%) in the study group and 115/151 (76%) in the control. There was no significant difference. The incidence of peritonitis caused by SA among all peritonitis cases was 3/6 (50%) in the study group and 17/42 (40%) in the control group, showing no significant difference. There was no significant difference in the overall incidence of ESI, peritonitis, or replacement of PD catheters between the study group and the control group.
Conclusion:
Intranasal mupirocin ointment did not prevent ESI. Further study is needed to develop an effective method of preventing ESI in pediatric PD patients.