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Effect of local mupirocin application on exit-site infection and peritonitis in an Indian peritoneal dialysis
Sandeep Mahajan1, Suresh C Tiwari, Vikram Kalra
1Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar. mahajansn@yahoo.com
Background:
Staphylococcus aureus-associated peritonitis and catheter exit-site infections (ESIs) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis. Intranasal and topical use of mupirocin has been found to be an effective strategy in decreasing S. aureus-related infectious complications in persons who are carriers of S. aureus; however, there is no consensus regarding the prophylactic use of mupirocin irrespective of carrier status. We aimed to determine the potential effectiveness of application of mupirocin cream at the catheter exit site in preventing ESI and peritonitis irrespective of carrier status in a tropical country such as India.
Methods:
This prospective historically controlled study was done in a total of 40 patients. From August 2003, all patients, incident and prevalent, were instructed to apply 2% mupirocin cream daily to the exit site instead of the older practice of povidone-iodine and gauze dressing. Patients were not screened to determine whether they were S. aureus carriers. The infection-related data for 1 year, until July 2004, were compared with the historical control, which was infection-related data for the year preceding the year of mupirocin application.
Results:
Mean age of the study population was 62 years, with 61.8% being male and 64.3% being diabetic. Local application of mupirocin led to a significant reduction in the incidence density per patient-month of both ESI and peritonitis compared to controls (0.15 vs 0.37 and 0.37 vs 0.67, p = 0.01 for both). This amounted to a relative reduction of 60.5% and 55% respectively. ESI and peritonitis due to S. aureus were also significantly lower in the study group compared to controls (incidence density per patient-month 0.05 vs 0.13 and zero vs 0.17 respectively, p < 0.01 for both). There occurred no catheter removal due to infection-related complications during the study period compared to two during the control period. None of the patients reported a mupirocin-related adverse effect.
Conclusions:
Daily application of mupirocin at the exit site is a well-tolerated and effective strategy in reducing the incidence of ESI and peritonitis in a tropical country such as India. It can thus significantly reduce morbidity, catheter loss, and transfer to hemodialysis in peritoneal dialysis patients.
Insights
Daily mupirocin cream application at the exit site significantly reduced catheter-related infections like peritonitis and exit-site infections (ESIs) in peritoneal dialysis patients in India. This well-tolerated strategy lowers hospitalization and catheter loss.
Area of Science:
- Nephrology and Infectious Diseases
- Peritoneal Dialysis Complications
- Antimicrobial Prophylaxis
Background:
- Staphylococcus aureus peritonitis and exit-site infections (ESIs) are major causes of hospitalization and catheter loss in chronic peritoneal dialysis (PD) patients.
- Mupirocin use (intranasal/topical) is effective for S. aureus carriers, but its prophylactic use regardless of carrier status lacks consensus.
- The study investigated mupirocin cream application at the exit site to prevent ESIs and peritonitis in India, irrespective of carrier status.
Purpose of the Study:
- To evaluate the effectiveness of daily 2% mupirocin cream application at the catheter exit site for preventing ESIs and peritonitis in PD patients.
- To assess the efficacy of mupirocin prophylaxis irrespective of Staphylococcus aureus carrier status.
- To determine the safety and tolerability of mupirocin application in a tropical climate.
Main Methods:
- A prospective, historically controlled study involving 40 PD patients in India.
- Patients applied 2% mupirocin cream daily to the exit site, replacing povidone-iodine and gauze.
- Infection data (ESI, peritonitis) over one year were compared with historical data from the preceding year; S. aureus carrier status was not determined.
Main Results:
- Mupirocin application significantly reduced the incidence density of both ESIs (0.15 vs. 0.37 per patient-month) and peritonitis (0.37 vs. 0.67 per patient-month) compared to controls (p=0.01 for both).
- S. aureus-related ESIs and peritonitis were significantly lower in the mupirocin group (incidence density 0.05 vs. 0.13 and 0 vs. 0.17, respectively; p<0.01).
- No catheter removals due to infection occurred during the study, versus two in the control period; mupirocin was well-tolerated with no reported adverse effects.
Conclusions:
- Daily mupirocin exit-site application is a safe, well-tolerated, and effective prophylactic strategy against ESIs and peritonitis in PD patients in India.
- This intervention significantly reduces infection-related morbidity, catheter loss, and the need for transfer to hemodialysis.
- The findings support the use of mupirocin prophylaxis regardless of S. aureus carrier status in PD patients, particularly in tropical regions.
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