Topical mupirocin/sodium hypochlorite reduces peritonitis and exit-site infection rates in children

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Renal Replacement Therapy

Background:

• Peritoneal dialysis (PD) is a common treatment for pediatric end-stage renal disease (ESRD).
• Infectious complications, including peritonitis and catheter exit site/tunnel infections (ESI/TI), frequently compromise PD therapy in children.
• Routine daily exit site care is crucial for preventing these infections.

Purpose of the Study:

• To evaluate the effectiveness of topical mupirocin (Mup) and sodium hypochlorite (NaOCl) solution in daily exit site care.
• To assess the impact of this combined approach on peritonitis and ESI/TI rates in pediatric PD patients.
• To analyze causative microorganisms and catheter survival rates associated with different exit site care protocols.

Main Methods:

• A retrospective chart review was conducted on pediatric patients undergoing home continuous cycling PD.
• Infection rates were compared between two periods: Mup alone and a combination of Mup and NaOCl (Mup+NaOCl).
• Data collected included annualized infection rates, microbial profiles, and catheter survival.

Main Results:

• The combination Mup+NaOCl significantly reduced annualized rates of peritonitis (1.2 to 0.26) and ESI/TI (1.36 to 0.33) compared to Mup alone (P < 0.0001 for both).
• No Mup-resistant organisms were observed. Gram-negative peritonitis also decreased significantly (AR 0.31 to 0.07, P < 0.001).
• Infection-related catheter removal rates decreased, and catheter survival was significantly prolonged in the Mup+NaOCl group (P < 0.009).

Conclusions:

• The combination of Mup and NaOCl in daily exit site care is highly effective in reducing PD-associated infections in pediatric patients.
• This combined approach significantly improves catheter survival rates.
• Daily exit site care incorporating Mup+NaOCl represents a valuable strategy for managing pediatric PD patients.