title: A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters.
abstract: BACKGROUND
  Central venous catheters are frequently needed for the provision of haemodialysis, but their clinical usefulness is severely limited by infectious complications. The risk of such infections can be reduced by topical application of mupirocin to the exit sites of non-cuffed catheters or by the use of tunnelled, cuffed catheters. Whether mupirocin offers any additional protection against infection in patients with tunnelled, cuffed haemodialysis catheters has not been studied.
  
  
  METHODS
  An open-label, randomized controlled trial was performed comparing the effect of thrice-weekly exit site application of mupirocin (mupirocin group) vs no ointment (control group) on infection rates and catheter survival in patients receiving haemodialysis via a newly inserted, tunnelled, cuffed central venous catheter. All patients were followed until catheter removal and were monitored for the development of exit site infections and catheter-associated bacteraemias.
  
  
  RESULTS
  Fifty patients were enrolled in the study. Both the mupirocin (n=27) and control (n=23) groups were similar at baseline with respect to demographic characteristics, comorbid illnesses and causes of renal failure. Compared with controls, mupirocin-treated patients experienced significantly fewer catheter-related bacteraemias (7 vs 35%, P<0.01) and a longer time to first bacteraemia (log rank score 8.68, P<0.01). The beneficial effect of mupirocin was entirely attributable to a reduction in staphylococcal infection (log rank 10.69, P=0.001) and was still observed when only patients without prior nasal Staphylococcus aureus carriage were included in the analysis (log rank score 6.33, P=0.01). Median catheter survival was also significantly longer in the mupirocin group (108 vs 31 days, log rank score 5.9, P<0.05). Mupirocin use was not associated with any adverse patient effects or the induction of antimicrobial resistance.
  
  
  CONCLUSIONS
  Thrice-weekly application of mupirocin to tunnelled, cuffed haemodialysis catheter exit sites is associated with a marked reduction in line-related sepsis and a prolongation of catheter survival.
authors.affiliation: Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia. david_johnson@health.qld.gov.au
authors.forename: David Wayne
authors.initials: DW
authors.lastname: Johnson
authors.forename: Robert
authors.initials: R
authors.lastname: MacGinley
authors.forename: Troy David
authors.initials: TD
authors.lastname: Kay
authors.forename: Carmel Mary
authors.initials: CM
authors.lastname: Hawley
authors.forename: Scott Bryan
authors.initials: SB
authors.lastname: Campbell
authors.forename: Nicole Maree
authors.initials: NM
authors.lastname: Isbel
authors.forename: Peter
authors.initials: P
authors.lastname: Hollett
mesh_terms: D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects; D016527:Drug Costs; D004867:Equipment Design; D006801:Humans; D017053:Infection Control / Q000379:methods*; D016712:Mupirocin / Q000008:administration & dosage* / Q000191:economics; D011552:Pseudomonas Infections / Q000453:epidemiology; D006435:Renal Dialysis / Q000295:instrumentation*; D013203:Staphylococcal Infections / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin