mupirocin and Infections

Catheter-related infections remain a serious problem for patients on peritoneal dialysis. Such infections can be reduced by careful patient selection and training, by the use of the best connection technology and screening and treating nasal carriage. To date, treatment is less than optimal and therefore, the primary goal should be prevention of catheter-related infections. Prevention is based on improving catheter design and implantation technique, while providing careful exit-site care. Regardless of how it is implemented, we must aggressively pursue the prevention of catheter-related infections by eradicating S. aureus exit-site carriage in PD patients. Based on its effectiveness in adult PD patients, its low rate of adverse effects, and its reasonable cost-effectiveness, application of mupirocin ointment at the exit-site is the current method of choice for preventing PD catheter infections caused by S. aureus. In addition to reducing S. aureus exit-site infections, mupirocin seems to reduce the rates of staphylococcal peritonitis and PD catheter loss. Whether the ointment should be applied in the nares, to the exit-site or both, and whether it should be used only in staphylococcal nasal carriers or all PD patients requires further study.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Catheters, Indwelling; Equipment Design; Humans; Infections; Mupirocin; Peritoneal Dialysis, Continuous Ambulatory; Primary Prevention; Randomized Controlled Trials as Topic; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

In the hemodialytic population, infections are the second leading cause of death; access infections account for a large proportion of this mortality. The antibiotic lock technique has been applied to infected tunneled catheters as rescue or prophylaxis medication to reduce infection rates. In addition, application of topical antibiotic ointments to tunneled and non-tunneled catheters also prevents exit site infections.. 17 patients with 25 catheters participated in our study from March 2004 - February 2005. The catheter lock comprised of mixed cefazolin (5 mg/dl) with heparin (2,500 IU/ml) and mupirocin was topically applied to the area (2 x 2 cm) surrounding the catheter exit site.. The catheter infection rate was reduced from 12.7 times/1,000 catheter days to 5.02 times/1,000 catheter days in patients with jugular vein catheters. The total catheter-related infection rate was 14.9 times/1,000 catheter days in the control group and 4.1 times/1,000 catheter days in the study group. The reduction in catheter infections was more evident in a subgroup of non-diabetic patients, and in those with femoral catheters.. The use of antibiotic lock and topical antibiotics significantly reduces the incidence of temporary catheter-related infections, especially in non-diabetic patients and in those with femoral catheters.

Topics: Administration, Topical; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteremia; Catheterization; Cefazolin; Control Groups; Cross Infection; Equipment Contamination; Erythema; Female; Fistula; Hemodialysis Units, Hospital; Heparin; Humans; Incidence; Infections; Kidney Failure, Chronic; Male; Middle Aged; Mupirocin; Prospective Studies; Renal Dialysis

Topics: Carrier State; Catheters, Indwelling; Humans; Infections; Mupirocin; Nasal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Risk Factors; Staphylococcal Infections; Staphylococcus aureus