title: A randomized controlled trial comparing mupirocin and polysporin triple ointments in peritoneal dialysis patients: the MP3 Study.
abstract: OBJECTIVE
  Infectious complications remain a significant cause of peritoneal dialysis (PD) technique failure. Topical ointments seem to reduce peritonitis; however, concerns over resistance have led to a quest for alternative agents. This study examined the effectiveness of applying topical Polysporin Triple ointment (P(3)) against mupirocin in a multi-centered, double-blind, randomized controlled trial.
  
  
  METHODS
  PD patients routinely applied either P(3) or mupirocin ointment to their exit site. Patients were followed for 18 months or until death or catheter removal. The primary study outcome was a composite endpoint of exit-site infection (ESI), tunnel infection, or peritonitis.
  
  
  RESULTS
  Seventy-five of 201 randomized patients experienced a primary outcome event (51 peritonitis episodes, 24 ESIs). No difference was seen in the time to first event for P(3) (13.2 months; 95% confidence interval, 11.9-14.5) and mupirocin (14.0 months; 95% confidence interval, 12.7-15.4) (P=0.41). Twice as many patients reported redness at the exit site in the P(3) group (14 versus 6, P=0.10). Over the complete study period, a higher rate per year of fungal ESIs was seen in patients using P(3) (0.07 versus 0.01; P=0.02) with a corresponding increase in fungal peritonitis (0.04 versus 0.00, respectively; P<0.05).
  
  
  CONCLUSIONS
  This study shows that P(3) is not superior to mupirocin in the prophylaxis of PD-related infections. Colonization of the exit site with fungal organisms is of concern and warrants further study. As such, the use of P(3) over mupirocin is not advocated in the prophylaxis of PD-related infections.
authors: Division of Nephrology, University Health Network, Toronto, Canada.
authors: Rory F
authors: RF
authors: McQuillan
authors: Ernest
authors: E
authors: Chiu
authors: Sharon
authors: S
authors: Nessim
authors: Charmaine E
authors: CE
authors: Lok
authors: Janet M
authors: JM
authors: Roscoe
authors: Paul
authors: P
authors: Tam
authors: Sarbjit Vanita
authors: SV
authors: Jassal
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D001414:Bacitracin / Q000008:administration & dosage* / Q000009:adverse effects; D055499:Catheter-Related Infections / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D018572:Disease-Free Survival; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006096:Gramicidin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage* / Q000009:adverse effects; D009181:Mycoses / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D009864:Ontario; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D010538:Peritonitis / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D011112:Polymyxin B / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; C420142:polysporin ointment; D001414:Bacitracin; D006096:Gramicidin; D016712:Mupirocin; D011112:Polymyxin B