Mahajan Sandeep, Tiwari Suresh C, Kalra Vikram, Bhowmik Dipankar M, Agarwal Sanjay K, Dash Suresh C, Kumar Parveen
Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar.
Perit Dial Int. 2005 Sep-Oct;25(5):473-7.
Staphylococcus aureus-associated peritonitis and catheter exit-site infections (ESIs) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis. Intranasal and topical use of mupirocin has been found to be an effective strategy in decreasing S. aureus-related infectious complications in persons who are carriers of S. aureus; however, there is no consensus regarding the prophylactic use of mupirocin irrespective of carrier status. We aimed to determine the potential effectiveness of application of mupirocin cream at the catheter exit site in preventing ESI and peritonitis irrespective of carrier status in a tropical country such as India.
This prospective historically controlled study was done in a total of 40 patients. From August 2003, all patients, incident and prevalent, were instructed to apply 2% mupirocin cream daily to the exit site instead of the older practice of povidone-iodine and gauze dressing. Patients were not screened to determine whether they were S. aureus carriers. The infection-related data for 1 year, until July 2004, were compared with the historical control, which was infection-related data for the year preceding the year of mupirocin application.
Mean age of the study population was 62 years, with 61.8% being male and 64.3% being diabetic. Local application of mupirocin led to a significant reduction in the incidence density per patient-month of both ESI and peritonitis compared to controls (0.15 vs 0.37 and 0.37 vs 0.67, p = 0.01 for both). This amounted to a relative reduction of 60.5% and 55% respectively. ESI and peritonitis due to S. aureus were also significantly lower in the study group compared to controls (incidence density per patient-month 0.05 vs 0.13 and zero vs 0.17 respectively, p < 0.01 for both). There occurred no catheter removal due to infection-related complications during the study period compared to two during the control period. None of the patients reported a mupirocin-related adverse effect.
Daily application of mupirocin at the exit site is a well-tolerated and effective strategy in reducing the incidence of ESI and peritonitis in a tropical country such as India. It can thus significantly reduce morbidity, catheter loss, and transfer to hemodialysis in peritoneal dialysis patients.
金黄色葡萄球菌相关的腹膜炎和导管出口处感染（ESI）是慢性腹膜透析患者住院和导管丢失的重要原因。已发现鼻内和局部使用莫匹罗星是降低金黄色葡萄球菌携带者金黄色葡萄球菌相关感染并发症的有效策略；然而，对于无论携带者状态如何预防性使用莫匹罗星尚无共识。我们旨在确定在印度这样的热带国家，无论携带者状态如何，在导管出口处涂抹莫匹罗星乳膏预防ESI和腹膜炎的潜在效果。
这项前瞻性历史对照研究共纳入40例患者。从2003年8月起，所有新发病例和现患病例患者均被指示每天在出口处涂抹2%莫匹罗星乳膏，而不是以往使用聚维酮碘和纱布敷料的做法。未对患者进行筛查以确定他们是否为金黄色葡萄球菌携带者。将截至2004年7月的1年感染相关数据与历史对照进行比较，历史对照为莫匹罗星应用年份前一年的感染相关数据。
研究人群的平均年龄为62岁，男性占61.8%，糖尿病患者占64.3%。与对照组相比，局部应用莫匹罗星导致ESI和腹膜炎的每患者月发病密度显著降低（分别为0.15对0.37和0.37对0.67，两者p = 0.01）。这分别相当于相对降低了60.5%和55%。与对照组相比，研究组中由金黄色葡萄球菌引起的ESI和腹膜炎也显著更低（每患者月发病密度分别为0.05对0.13和零对0.17，两者p < 0.01）。与对照期的两例相比，研究期间未因感染相关并发症而拔除导管。没有患者报告与莫匹罗星相关的不良反应。
在印度这样的热带国家，每天在出口处涂抹莫匹罗星是一种耐受性良好且有效的策略，可降低ESI和腹膜炎的发生率。因此，它可以显著降低腹膜透析患者的发病率、导管丢失率以及转为血液透析的比例。
