title: A randomized trial of Staphylococcus aureus prophylaxis in peritoneal dialysis patients: mupirocin calcium ointment 2% applied to the exit site versus cyclic oral rifampin.
abstract: The objective of this study was to compare prophylaxis for Staphylococcus aureus infections in peritoneal dialysis patients using 600 mg cyclic oral rifampin for 5 days every 3 months versus mupirocin calcium ointment 2% applied daily to the exit site. The study design was a prospective randomized trial, controlling for S aureus nasal carriage. Eighty-two continuous ambulatory and continuous cyclic peritoneal dialysis patients (54% male, 71 % white, 34% insulin-dependent, mean prestudy time on peritoneal dialysis 1.2 years) were randomly assigned to cyclic rifampin (n = 41 patients) or daily exit site mupirocin prophylaxis (n = 41 patients). Mean follow-up was 1 year. S aureus catheter infection rates were 0.13/yr with mupirocin and 0.15/yr with rifampin (P = NS). Both rates were significantly lower than the center's historical rate (the period between 1983 and 1992) of 0.46/yr prior to the study (P < 0.001). S aureus peritonitis rates were 0.04/yr with mupirocin and 0.02/yr with rifampin (P = NS), both significantly lower than the center's historical rate of 0.16/yr (P < 0.02). Catheter loss due to S aureus infections was 0.02/yr with mupirocin and 0/yr with rifampin (P = NS), both significantly lower than the center's historical rate of 0.12/yr (P < 0.001). There were no side effects in patients using mupirocin, but 12% were unable to continue rifampin due to side effects. We conclude that mupirocin ointment at the exit site and cyclic oral rifampin are equally effective in reducing S aureus catheter infections. In addition, rifampin or mupirocin significantly reduced S aureus peritonitis and catheter loss due to S aureus infections. Mupirocin at the exit site provides an excellent alternative prophylaxis for S aureus infections, particularly in patients who cannot tolerate oral rifampin therapy.
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh Medical Center, PA 15213, USA.
authors.forename: J
authors.initials: J
authors.lastname: Bernardini
authors.forename: B
authors.initials: B
authors.lastname: Piraino
authors.forename: J
authors.initials: J
authors.lastname: Holley
authors.forename: J R
authors.initials: JR
authors.lastname: Johnston
authors.forename: R
authors.initials: R
authors.lastname: Lutes
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002408:Catheters, Indwelling / Q000009:adverse effects; D018890:Chemoprevention; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004334:Drug Administration Schedule; D004866:Equipment Contamination; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016712:Mupirocin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009666:Nose / Q000382:microbiology; D009824:Ointments; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000295:instrumentation; D010538:Peritonitis / Q000382:microbiology / Q000517:prevention & control; D011446:Prospective Studies; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D009824:Ointments; D016712:Mupirocin; D012293:Rifampin