STAPHYLOCOCCUS-AUREUS PROPHYLAXIS IN HEMODIALYSIS-PATIENTS USING CENTRAL VENOUS CATHETER, EFFECT OF MUPIROCIN OINTMENT

Central venous catheterization is a common technique to establish rapi d and temporary access for hemodialysis. However, it is a known risk f actor for Staphylococcus aureus infection and bacteremia. Mupirocin is a topical antibiotic with high in vitro anti-staphylococcal activity. A randomized prospective trial was conducted to assess the effectiven ess of mupirocin ointment in the prevention of Staphylococcus aureus s kin and catheter colonization, and episodes of bacteremia in 136 end-s tage renal disease patients. Of these, 67 received skin disinfection a t the venous catheter insertion site with povidone iodine (control gro up), and 69 received the same treatment followed by application of 2% mupirocin ointment at the cannula site after catheter placement and at the end of each dialysis session. Patients were followed until cathet er removal and were monitored for the development of Staphylococcus au reus skin/catheter colonization and episodes of bacteremia. Median dur ation of catheter use was greater in the mupirocin than in the control group (37 versus 20 d, P < 0.01). Patients in the mupirocin group had a significantly lower rate of Staphylococcus aureus isolation from th e pericatheter skin (1.76 per 1000 versus 14.27 per 1000 patient-days, P < 0.001) and from the catheter surface (3.17 per 1000 versus 14.27 per 1000 patient-days, P < 0.001). The proportion of patients with Sta phylococcus aureus skin infection at the insertion site was lower in t he mupirocin group (4.3% versus 23.9%, P = 0.001). Staphylococcus aure us-associated bacteremia was observed in 17 patients (two in the mupir ocin group [0.71 episodes per 1000 patient-days] and 15 in the control group [8.92 per 1000 patient-days], P < 0.001). The hazard ratio of d eveloping Staphylococcus aureus bacteremia was 7.2 (95% confidence int erval, 1.6 to 31.6) times greater in patients not receiving mupirocin. Mupirocin applied to the insertion site significantly reduces the ris k of Staphylococcus aureus skin and catheter colonization, exit-site i nfection, and Staphylococcus aureus bacteremia in hemodialysis patient s.