A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters.
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.
Johnson
David Wayne
DW
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia. david_johnson@health.qld.gov.au
MacGinley
Robert
R
Kay
Troy David
TD
Hawley
Carmel Mary
CM
Campbell
Scott Bryan
SB
Isbel
Nicole Maree
NM
Hollett
Peter
P
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
D000900:Anti-Bacterial Agents; D016712:Mupirocin