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
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)