title: Prevention of peritoneal dialysis catheter infections in Saudi peritoneal dialysis patients: the emergence of high-level mupirocin resistance.
abstract: OBJECTIVE
  Exit-site infection (ESI) and peritonitis remain the major causes of morbidity and mortality in peritoneal dialysis (PD) patients. This study compared the effectiveness of local mupirocin ointment and gentamicin cream in preventing both gram-positive and gram-negative bacterial infections in PD patients.
  
  
  METHODS
  Patients from two centers (n = 203) were assigned to daily mupirocin ointment or gentamicin cream application. Infections were tracked prospectively by organisms and expressed as episodes per patient-year for both ESI and peritonitis.
  
  
  RESULTS
  The rate of gram-positive ESI was 0.31/episode/patient-year and 0.22 episodes/patient-year (p<0.05), whereas the rate of gram-negative ESI was 0.28 episode/patient-year and 0.11 episode/patient-year (p<0.01) in the mupirocin group and gentamicin group, respectively. Gram-positive ESI occurred in 17.1% vs 10.2% of patients (p<0.05), whereas 20% of and 5.1% of patients (p<0.001) had gram-negative ESI in the 2 groups respectively. S.aureus was cultured at exit-site in the mupirocin group in 27.8% patients, 60% (16.7% of the total Gram-positive isolates) of them being with high-level mupirocin-resistance. Pseudomonas aeruginosa was cultured in 21.8% of ESI in the mupirocin group, and in only 6.7% in the gentamicin group (p<0.01). Peritonitis rates were lower using gentamicin cream, 0.17 episode/patient-year compared with mupirocin, 0.39 episode/patient-year (p<0.01). With multivariate analysis, only gentamicin exit-site use was a significant predictor for lower catheter infection rate.
  
  
  CONCLUSIONS
  Prolonged use of mupirocin for ESI-prophylaxis is associated with the emergence of mupirocin-resistant S. aureus. Gentamicin cream is superior to mupirocin ointment in the prevention of PD catheter infections.
authors.affiliation: Department of Internal Medicine, Nephrology Division, King Fahd University Hospital, University of Dammam, Saudi Arabia.
authors.forename: Abdullah K
authors.initials: AK
authors.lastname: Al-Hwiesh
authors.forename: Ibrahiem Saeed
authors.initials: IS
authors.lastname: Abdul-Rahman
authors.forename: Fahd Abdulaziz
authors.initials: FA
authors.lastname: Al-Muhanna
authors.forename: Mohammed Hamad
authors.initials: MH
authors.lastname: Al-Sulaiman
authors.forename: Mohammed Shami
authors.initials: MS
authors.lastname: Al-Jondebi
authors.forename: Jose Carolino
authors.initials: JC
authors.lastname: Divino-Filho
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D024881:Drug Resistance, Bacterial; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009824:Ointments; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D010538:Peritonitis / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012529:Saudi Arabia; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D009824:Ointments; D016712:Mupirocin