Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia.
School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.
Respirology. 2024 Feb;29(2):176-182. doi: 10.1111/resp.14595. Epub 2023 Sep 11.
Indwelling pleural catheter (IPC) and indwelling peritoneal catheter (IPeC) have established roles in the management of malignant pleural and peritoneal effusions but catheter-related infections remain a major concern. Topical mupirocin prophylaxis has been shown to reduce peritoneal dialysis catheter infections. This study aimed to assess the (i) compatibility of IPC with mupirocin and (ii) feasibility, tolerability and compliance of topical mupirocin prophylaxis in patients with an IPC or IPeC.
(i) Three preparations of mupirocin were applied onto segments of IPC thrice weekly and examined with scanning electron microscope (SEM) at different time intervals. (ii) Consecutive patients fitted with IPC or IPeC were given topical mupirocin prophylaxis to apply to the catheter exit-site following every drainage/dressing change (at least twice weekly) and followed up for 6 months.
(i) No detectable structural catheter damage was found with mupirocin applied for up to 6 months. (ii) Fifty indwelling catheters were inserted in 48 patients for malignant pleural (n = 41) and peritoneal (n = 9) effusions. Median follow-up was 121 [median, IQR 19-181] days. All patients tolerated mupirocin well; one patient reported short-term local tenderness. Compliance was excellent with 95.8% of the 989 scheduled doses delivered. Six patients developed catheter-related pleural (n = 3), concurrent peritoneal/local (n = 1) and skin/tract (n = 2) infections from Streptococcus mitis (with Bacillus species or anaerobes), Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa.
This first study of long-term prevention of IPC- or IPeC-related infections found topical mupirocin prophylaxis feasible and well tolerated. Its efficacy warrants future randomized studies.
留置性胸腔导管（IPC）和留置性腹膜导管（IPeC）在恶性胸腔和腹腔积液的管理中已确立了作用，但导管相关性感染仍然是一个主要关注点。局部莫匹罗星预防已被证明可降低腹膜透析导管感染。本研究旨在评估：（i）IPC 与莫匹罗星的相容性；（ii）IPC 或 IPeC 患者局部莫匹罗星预防的可行性、可耐受性和依从性。
（i）每周三次将三种莫匹罗星制剂应用于 IPC 段，并在不同时间间隔使用扫描电子显微镜（SEM）进行检查。（ii）连续入组接受 IPC 或 IPeC 置管的患者，在每次引流/换药后（至少每周两次）将莫匹罗星预防制剂应用于导管出口部位，并进行 6 个月的随访。
（i）莫匹罗星应用长达 6 个月未发现可检测到的结构导管损伤。（ii）48 例患者共置入 50 根留置导管，用于恶性胸腔（n=41）和腹腔（n=9）积液。中位随访时间为 121 天[中位数，IQR 19-181]。所有患者均能耐受莫匹罗星，1 例患者报告短期局部压痛。989 次计划剂量中有 95.8%得到了极好的依从性。6 例患者发生导管相关性胸腔（n=3）、同期腹腔/局部（n=1）和皮肤/窦道（n=2）感染，病原体分别为缓症链球菌（伴芽孢杆菌或厌氧菌）、金黄色葡萄球菌、肺炎克雷伯菌和铜绿假单胞菌。
这是首例关于 IPC 或 IPeC 相关感染的长期预防研究，发现局部莫匹罗星预防是可行且耐受良好的。其疗效值得进一步开展随机研究。
