title: Randomized, controlled trial of topical exit-site application of honey (Medihoney) versus mupirocin for the prevention of catheter-associated infections in hemodialysis patients.
abstract: The clinical usefulness of hemodialysis catheters is limited by increased infectious morbidity and mortality. Topical antiseptic agents, such as mupirocin, are effective at reducing this risk but have been reported to select for antibiotic-resistant strains. The aim of the present study was to determine the efficacy and the safety of exit-site application of a standardized antibacterial honey versus mupirocin in preventing catheter-associated infections. A randomized, controlled trial was performed comparing the effect of thrice-weekly exit-site application of Medihoney versus mupirocin on infection rates in patients who were receiving hemodialysis via tunneled, cuffed central venous catheters. A total of 101 patients were enrolled. The incidences of catheter-associated bacteremias in honey-treated (n = 51) and mupirocin-treated (n = 50) patients were comparable (0.97 versus 0.85 episodes per 1000 catheter-days, respectively; NS). On Cox proportional hazards model analysis, the use of honey was not significantly associated with bacteremia-free survival (unadjusted hazard ratio, 0.94; 95% confidence interval, 0.27 to 3.24; P = 0.92). No exit-site infections occurred. During the study period, 2% of staphylococcal isolates within the hospital were mupirocin resistant. Thrice-weekly application of standardized antibacterial honey to hemodialysis catheter exit sites was safe, cheap, and effective and resulted in a comparable rate of catheter-associated infection to that obtained with mupirocin (although the study was not adequately powered to assess therapeutic equivalence). The effectiveness of honey against antibiotic-resistant microorganisms and its low likelihood of selecting for further resistant strains suggest that this agent may represent a satisfactory alternative means of chemoprophylaxis in patients with central venous catheters.
authors.affiliation: Department of Renal Medicine, Level 2, Ambulatory Renal and Transplant Services Building, University of Queensland at Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Queensland 4102, Australia. david_johnson@health.qld.gov.au
authors.forename: David Wayne
authors.initials: DW
authors.lastname: Johnson
authors.forename: Carolyn
authors.initials: C
authors.lastname: van Eps
authors.forename: David William
authors.initials: DW
authors.lastname: Mudge
authors.forename: Kathryn Joan
authors.initials: KJ
authors.lastname: Wiggins
authors.forename: Kirsty
authors.initials: K
authors.lastname: Armstrong
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: Graeme Robert
authors.initials: GR
authors.lastname: Nimmo
authors.forename: Harry
authors.initials: H
authors.lastname: Gibbs
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D001458:Bandages; D002405:Catheterization, Central Venous; D018572:Disease-Free Survival; D016527:Drug Costs; D005260:Female; D006722:Honey / Q000009:adverse effects / Q000191:economics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D006435:Renal Dialysis; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin