Thodis E, Passadakis P, Panagoutsos S, Bacharaki D, Euthimiadou A, Vargemezis V
Department of Nephrology, Medical School, Democritus University of Thrace, Greece.
Adv Perit Dial. 2000;16:257-61.
The objective of this study was to evaluate the effectiveness of mupirocin on Staphylococcus aureus with regard to peritoneal dialysis (PD)-catheter exit-site infections (ESI), tunnel infections (TI), and peritonitis episodes (PE). The study was performed on 42 continuous ambulatory peritoneal dialysis (CAPD) patients (group I) treated from April 1998 to July 1999. These patients were instructed to apply mupirocin daily at the catheter exit site as part of their exit-site care. The control was the same group's historical infection data. Results were also recorded for a second group of 16 patients (group II) with newly implanted PD catheters were also instructed to apply mupirocin at the exit site daily. During the control period (before daily mupirocin application), group I recorded 16 episodes of ESI (0.30 episodes per patient-year), 6 episodes of TI (0.11 episodes per patient-year), 15 episodes of PE (0.28 episodes per patient-year), and one case of catheter removal (0.019 episodes per patient-year) owing to S. aureus exit-site infection coexisting with peritonitis. The rate of S. aureus exit-site infection during this period was 0.11 episodes per patient-year; of S. aureus tunnel infection, 0.057 episodes per patient-year; and of S. aureus peritonitis, 0.076 episodes per patient-year. During the mupirocin period, infections and peritonitis owing to S. aureus dramatically decreased (p < 0.01 and p < 0.001 respectively). The rate of S. aureus exit-site infection was 0.02 episodes per patient-year, with no S. aureus tunnel infections, and no catheter removals owing to S. aureus peritonitis. Similarly, in group II, no episodes were recorded of any ESI, TI, or PE owing to S. aureus, although 4 episodes of ESI (0.37 episodes per patient-year, 2 with other gram-positive bacteria, and 2 with gram-negative bacteria) and 8 PEs (0.75 episodes per patient-year) were seen. We conclude that mupirocin application provides excellent prophylaxis for catheter-related infections owing to S. aureus, and that reduction of these infections may improve the long-term survival of patients on CAPD.
本研究的目的是评估莫匹罗星对腹膜透析（PD）导管出口部位感染（ESI）、隧道感染（TI）和腹膜炎发作（PE）的金黄色葡萄球菌的有效性。该研究对1998年4月至1999年7月期间接受治疗的42例持续性非卧床腹膜透析（CAPD）患者（I组）进行。这些患者被指示每天在导管出口部位涂抹莫匹罗星作为出口部位护理的一部分。对照组为同一组患者的历史感染数据。还记录了第二组16例新植入PD导管的患者（II组）的结果，他们也被指示每天在出口部位涂抹莫匹罗星。在对照期（每天应用莫匹罗星之前），I组记录了16例ESI发作（每位患者每年0.30例）、6例TI发作（每位患者每年0.11例）、15例PE发作（每位患者每年0.28例），以及1例因金黄色葡萄球菌出口部位感染合并腹膜炎而拔除导管的病例（每位患者每年0.019例）。在此期间，金黄色葡萄球菌出口部位感染率为每位患者每年0.11例；金黄色葡萄球菌隧道感染率为每位患者每年0.057例；金黄色葡萄球菌腹膜炎率为每位患者每年0.076例。在应用莫匹罗星期间，金黄色葡萄球菌引起的感染和腹膜炎显著减少（分别为p<0.01和p<0.001）。金黄色葡萄球菌出口部位感染率为每位患者每年0.02例，无金黄色葡萄球菌隧道感染，也无因金黄色葡萄球菌腹膜炎而拔除导管的情况。同样，在II组中，未记录到任何因金黄色葡萄球菌引起的ESI、TI或PE发作，尽管观察到4例ESI发作（每位患者每年0.37例，2例由其他革兰氏阳性菌引起，并2例由革兰氏阴性菌引起）和8例PE发作（每位患者每年0.75例）。我们得出结论，涂抹莫匹罗星可为金黄色葡萄球菌引起的导管相关感染提供出色的预防作用，并且减少这些感染可能会提高CAPD患者的长期生存率。
