HDCN Article Review/Hyperlink

Bernardini J, Piraino B, Holley J, Johnston JR, Lutes R

A randomized trial of Staphylococcus aureus prophylaxis in peritoneal dialysis patients: mupirocin calcium ointment 2% applied to the exit site versus cyclic oral rifampin

Am J Kidney Dis (May) 27:695-700 1996

This is a randomized trial to assess the effectiveness of prophylaxis with 2% mupirocin ointment applied to the PD catheter exit site as part of routine daily care in prevention of S. aureus infections. The comparison treatment is cyclic oral rifampin (600 mg for five days every three months).

For the purpose of study S. aureus nasal carriage was defined as at least one S. aureus-positive nasal culture prior to and after the randomization. Eighty-two peritoneal dialysis patients were randomized to the two groups, 41 patients to each. Patient characteristics with regard to race, sex, renal disease, and PD duration were similar in both groups. Mean follow up was one year.

S. aureus exit site infection rates were similar in both groups (0.13/yr with mupirocin and 0.15 with rifampin). These rates were lower than the center's historical rate of 0.46/yr with rifampin given only to patients who were nasal carriers. S. aureus peritonitis was also lower in the study groups (0.04/yr and 0.02/yr respectively) compared to historical period (0.16/yr). Catheter loss rates were lower in both of the study groups compared to the historical control period.

Comment: The results suggest that topical application of 2% of mupirocin ointment to exit sites as a part of daily routine exit care of PD patients was as effective as cyclic oral rifampin and more effective than treating the nasal carriage state with oral rifampin. The authors recommend this approach as effective prophylaxis for S. aureus infections in PD patients. (Ramesh Khanna, M.D., University of Missouri, Columbia)