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Prophylaxis against gram-positive organisms causing exit-site infection and peritonitis in continuous ambulatory
Sunny S H Wong1, Kwok Hong Chu, Au Cheuk
1Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China. pmhrenal@hotmail.com
Objective:
We evaluated the effectiveness of local application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis attributable to gram-positive organisms in continuous ambulatory peritoneal dialysis patients.
Methods:
This prospective randomized controlled trial included 154 patients. They were randomly allocated to a mupirocin-treated group (group M) and a control group (group C). Group M included 73 patients (47.4%) who were instructed to apply mupirocin ointment to the catheter exit site once daily after the routine daily exit-site dressing. Group C included 81 patients (52.6%) who continued their usual daily exit-site care without applying mupirocin. The two groups were followed to see whether there would be any difference in the frequency of exit-site infection and peritonitis or in the infecting organisms.
Results:
Interim data were collected at 5 months after the start of the study. Those data showed a significantly lower incidence of exit-site infection and peritonitis attributable to gram-positive organisms in group M as compared with group C. The incidence of gram-positive exit-site infection in group C was 1 episode per 36.8 patient-months; in group M, the incidence was 1 episode per infinity patient-months (0 incidence in 5 months, p < 0.05). The incidence of gram-positive peritonitis in group C was 1 episode per 40.5 patient-months; in group M, the incidence was 1 episode per 365 patient-months (p < 0.05). Mupirocin treatment had no significant effect on the incidence of exit-site infection and peritonitis attributable to other organisms. Before mupirocin treatment, we saw a trend toward higher infection rates in diabetic patients and nasal carriers of Staphylococcus aureus as compared with non diabetic patients and nasal non carriers, although the differences were not statistically significant. Mupirocin brought the infection rate attributable to gram-positive organisms to an equally low level in diabetic and non-diabetic patients, and in nasal carriers and nasal non carriers of S. aureus. No adverse effect of local application of mupirocin was reported.
Conclusion:
Local application of mupirocin ointment at the catheter exit site is a safe and effective method of preventing exit-site infection and peritonitis involving gram-positive organisms.
Insights
Topical mupirocin ointment effectively prevents gram-positive exit-site infections and peritonitis in continuous ambulatory peritoneal dialysis patients. This safe and simple intervention significantly reduces infection rates, improving patient outcomes.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) patients are susceptible to exit-site infections (ESIs) and peritonitis, often caused by gram-positive organisms.
- Preventing these infections is crucial for maintaining the long-term efficacy and safety of peritoneal dialysis.
- Catheter exit-site care is a key factor in infection prevention strategies.
Purpose of the Study:
- To evaluate the effectiveness of mupirocin ointment applied locally at the catheter exit site.
- To determine if mupirocin prevents gram-positive exit-site infections and peritonitis in CAPD patients.
- To assess the safety and impact of mupirocin on infection rates in specific patient subgroups.
Main Methods:
- A prospective randomized controlled trial involving 154 CAPD patients.
- Patients were randomized into two groups: a mupirocin-treated group (daily application) and a control group (usual care).
- Follow-up assessed the incidence of exit-site infection and peritonitis and identified causative organisms.
Main Results:
- The mupirocin group showed a significantly lower incidence of gram-positive exit-site infections and peritonitis compared to the control group.
- Incidence of gram-positive ESI in the control group was 1 episode per 36.8 patient-months vs. 0 in the mupirocin group (p < 0.05).
- Incidence of gram-positive peritonitis in the control group was 1 episode per 40.5 patient-months vs. 1 episode per 365 patient-months in the mupirocin group (p < 0.05).
- Mupirocin had no significant effect on infections caused by other organisms.
- The treatment normalized infection rates in diabetic patients and Staphylococcus aureus nasal carriers.
- No adverse effects of local mupirocin application were reported.
Conclusions:
- Local application of mupirocin ointment at the catheter exit site is a safe and effective strategy.
- Mupirocin significantly reduces the incidence of exit-site infections and peritonitis caused by gram-positive organisms in CAPD patients.
- This intervention is beneficial for all CAPD patients, including those with diabetes or S. aureus nasal carriage.
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