title: The Effect of Exit-Site Antibacterial Honey Versus Nasal Mupirocin Prophylaxis on the Microbiology and Outcomes of Peritoneal Dialysis-Associated Peritonitis and Exit-Site Infections: A Sub-Study of the Honeypot Trial.
abstract: ♦
  
  
  BACKGROUND
  The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and technique failure. ♦
  
  
  METHODS
  A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care (N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis- and infection-associated hospitalization, and technique failure (PD withdrawal). ♦
  
  
  RESULTS
  The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32 - 0.50) and 0.41 (95% CI 0.33 - 0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75 - 1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66 - 1.49), gram-negative (IRR 0.71, 95% CI 0.39 - 1.29), culture-negative (IRR 2.01, 95% CI 0.91 - 4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36 - 3.20). Exit-site infection rates were 0.37 (95% CI 0.28 - 0.45) and 0.33 (95% CI 0.26 - 0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81 - 1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70 - 1.72), gram-negative (IRR: 0.85, 95% CI 0.46 - 1.58), culture-negative (IRR 1.88, 95% CI 0.67 - 5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40 - 2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. ♦
  
  
  CONCLUSIONS
  Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Badve
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Pascoe
authors.affiliation: Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia.
authors.forename: Elaine
authors.initials: E
authors.lastname: Beller
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Menzies School of Health Research, Darwin, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Nambour Hospital, Nambour, Australia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Clark
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand.
authors.forename: Janak
authors.initials: J
authors.lastname: de Zoysa
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Isbel
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Child & Adolescent Renal Service, Royal Children's and Mater Children's Hospitals, Brisbane, Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: McTaggart
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.
authors.forename: Alicia T
authors.initials: AT
authors.lastname: Morrish
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: E Geoffrey
authors.initials: EG
authors.lastname: Playford
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.
authors.forename: Anish
authors.initials: A
authors.lastname: Scaria
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Snelling
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.
authors.forename: Liza A
authors.initials: LA
authors.lastname: Vergara
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.affiliation: Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia david.johnson2@health.qld.gov.au.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D002408:Catheters, Indwelling; D005260:Female; D006722:Honey; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage*; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin
keywords: Honey; exit-site infection; hospitalization; microbiology; mupirocin; peritoneal dialysis related infection; peritonitis; technique failure