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

Zhang, Lei, Badve, Sunil V., Pascoe, Elaine M., Beller, Elaine, Cass, Alan, Clark, Carolyn, de Zoysa, Janak, Isbel, Nicole M., McTaggart, Steven, Morrish, Alicia T., Playford, E. Geoffrey, Scaria, Anish, Snelling, Paul, Vergara, Liza A., Hawley, Carmel M. and Johnson, David W. (2015) 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. Peritoneal Dialysis International, 35 7: 712-721. doi:10.3747/pdi.2014.00206


Author Zhang, Lei
Badve, Sunil V.
Pascoe, Elaine M.
Beller, Elaine
Cass, Alan
Clark, Carolyn
de Zoysa, Janak
Isbel, Nicole M.
McTaggart, Steven
Morrish, Alicia T.
Playford, E. Geoffrey
Scaria, Anish
Snelling, Paul
Vergara, Liza A.
Hawley, Carmel M.
Johnson, David W.
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
Journal name Peritoneal Dialysis International   Check publisher's open access policy
ISSN 0896-8608
1718-4304
Publication date 2015-12-01
Sub-type Article (original research)
DOI 10.3747/pdi.2014.00206
Open Access Status Not Open Access
Volume 35
Issue 7
Start page 712
End page 721
Total pages 10
Place of publication Milton, Canada
Publisher Multimed
Language eng
Formatted 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.

Conclusion:  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.
Keyword Honey
Peritonitis
Exit-site infection
Mupirocin
Microbiology
Hospitalization
Technique failure
Peritoneal dialysis related infection
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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