Lim Christopher Thiam-Seong, Wong Kok-Seng, Foo Marjore Wai-Yin
Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore 168751.
Nephrol Dial Transplant. 2005 Oct;20(10):2202-6. doi: 10.1093/ndt/gfi010. Epub 2005 Jul 26.
Peritonitis and exit-site infections (ESI) are major causes of morbidity in peritoneal dialysis (PD) patients. The application of topical mupirocin to exit sites reduces such complications, and prolongs life in PD. Since the year 2000, this topical treatment has been used in our hospital on new PD patients. We analysed the results of this protocol, and studied the effects of comorbidities on the incidence of peritonitis.
We studied 740 incident PD patients, who were divided into two groups based on year of entry into PD (Group 1 from January 1998 to December 1999 inclusive, topical mupirocin not used, and Group 2 from January 2000 to March 2004 inclusive, topical mupirocin used). The variables we studied included gender, age, diabetic status, ischaemic heart disease, peripheral vascular disease, cerebrovascular disease and serum albumin.
The application of topical mupirocin at the exit site led to a significant reduction in the rate of peritonitis (0.443 vs 0.339 episodes per patient-year; P<0.0005) and in ESI (0.168 vs 0.156 episodes per patient-year; P<0.005), results attributed primarily by the significant (P<0.005) reduction in Staphylococcus aureus infection. There was also an unexpected lowering of Pseudomonas aeruginosa peritonitis in the mupirocin group (P<0.005). Stepwise multiple logistic regression analysis revealed that only the application of mupirocin and serum albumin levels were significant predictors of peritonitis.
Our study, although retrospective, has demonstrated that the topical use of mupirocin was associated with a significant reduction in ESI and peritonitis and, unexpectedly, with findings of fewer incidences of Pseudomonas peritonitis. Serum albumin level before the initiation of PD was a strong predictor of subsequent peritonitis. Mupirocin, with its low toxicity, ease of application and demonstrable beneficial effect in reducing ESI and peritonitis is now used on all of our incident PD patients.
腹膜炎和出口处感染（ESI）是腹膜透析（PD）患者发病的主要原因。在出口处局部应用莫匹罗星可减少此类并发症，并延长PD患者的生命。自2000年以来，我院对新的PD患者采用了这种局部治疗方法。我们分析了该方案的结果，并研究了合并症对腹膜炎发病率的影响。
我们研究了740例新发病的PD患者，根据开始PD治疗的年份将其分为两组（第1组为1998年1月至1999年12月，未使用局部莫匹罗星；第2组为2000年1月至2004年3月，使用局部莫匹罗星）。我们研究的变量包括性别、年龄、糖尿病状态、缺血性心脏病、外周血管疾病、脑血管疾病和血清白蛋白。
在出口处局部应用莫匹罗星导致腹膜炎发生率显著降低（每位患者每年0.443次 vs 0.339次；P<0.0005）和ESI发生率显著降低（每位患者每年0.168次 vs 0.156次；P<0.005），这主要归因于金黄色葡萄球菌感染显著减少（P<0.005）。莫匹罗星组铜绿假单胞菌腹膜炎也意外地有所降低（P<0.005）。逐步多元逻辑回归分析显示，只有莫匹罗星的应用和血清白蛋白水平是腹膜炎的显著预测因素。
我们的研究虽然是回顾性的，但已表明局部应用莫匹罗星与ESI和腹膜炎显著减少相关，而且意外地发现铜绿假单胞菌腹膜炎的发生率更低。PD开始前的血清白蛋白水平是随后发生腹膜炎的有力预测因素。莫匹罗星毒性低、易于应用且在减少ESI和腹膜炎方面有明显有益效果，现在我们所有新发病的PD患者都使用它。
