NASAL MUPIROCIN PREVENTS STAPHYLOCOCCUS-AUREUS EXIT-SITE INFECTION DURING PERITONEAL-DIALYSIS

A total of 1144 patients receiving continuous ambulatory peritoneal di alysis in nine European centers was screened for nasal carriage of Sta phylococcus aureus. Two hundred sixty-seven subjects were defined as c arriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal oin tment twice daily for 5 consecutive days every 4 wk. The treatment gro up used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Wel wyn Garden City, United Kingdom) and the control group used placebo oi ntment. Patients were followed-up for a maximum period of 18 months. T here were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic da ta, cause of renal failure, type of catheter, system used, or method o f exit-site care between the groups. Similarly, there were no differen ces in patient outcome or incidence of adverse events between both gro ups., Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group an d 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin g roup and 44 in the control group (P = 0.006, mixed effects Poisson reg ression model). There were no differences in the rate of tunnel infect ion or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carri ers of S. aureus significantly reduces the rate of exit-site infection s that occurs because of this organism.