A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters

Johnson, David Wayne, MacGinley, Robert, Kay, Troy David, Hawley, Carmel Mary, Campbell, Scott Bryan, Isbel, Nicole Maree and Hollett, Peter (2002) A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters. Nephrology Dialysis Transplantation, 17 10: 1802-1807. doi:10.1093/ndt/17.10.1802


Author Johnson, David Wayne
MacGinley, Robert
Kay, Troy David
Hawley, Carmel Mary
Campbell, Scott Bryan
Isbel, Nicole Maree
Hollett, Peter
Title A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters
Journal name Nephrology Dialysis Transplantation   Check publisher's open access policy
ISSN 0931-0509
Publication date 2002-10-01
Year available 2002
Sub-type Article (original research)
DOI 10.1093/ndt/17.10.1802
Open Access Status DOI
Volume 17
Issue 10
Start page 1802
End page 1807
Total pages 6
Place of publication Oxford
Publisher Oxford University Press
Language eng
Subject C1
730118 Organs, diseases and abnormal conditions not elsewhere classified
110312 Nephrology and Urology
Abstract Background. Central venous catheters are frequently needed for the provision of haemodialysis, but their clinical usefulness is severely limited by infectious complications. The risk of such infections can be reduced by topical application of mupirocin to the exit sites of non-cuffed catheters or by the use of tunnelled, cuffed catheters. Whether mupirocin offers any additional protection against infection in patients with tunnelled, cuffed haemodialysis catheters has not been studied.
Formatted abstract
Background. Central venous catheters are frequently needed for the provision of haemodialysis, but their clinical usefulness is severely limited by infectious complications. The risk of such infections can be reduced by topical application of mupirocin to the exit sites of non-cuffed catheters or by the use of tunnelled, cuffed catheters. Whether mupirocin offers any additional protection against infection in patients with tunnelled, cuffed haemodialysis catheters has not been studied.

Methods. An open-label, randomized controlled trial was performed comparing the effect of thrice-weekly exit site application of mupirocin (mupirocin group) vs no ointment (control group) on infection rates and catheter survival in patients receiving haemodialysis via a newly inserted, tunnelled, cuffed central venous catheter. All patients were followed until catheter removal and were monitored for the development of exit site infections and catheter-associated bacteraemias.

Results. Fifty patients were enrolled in the study. Both the mupirocin (n=27) and control (n=23) groups were similar at baseline with respect to demographic characteristics, comorbid illnesses and causes of renal failure. Compared with controls, mupirocin-treated patients experienced significantly fewer catheter-related bacteraemias (7 vs 35%, P<0.01) and a longer time to first bacteraemia (log rank score 8.68, P<0.01). The beneficial effect of mupirocin was entirely attributable to a reduction in staphylococcal infection (log rank 10.69, P=0.001) and was still observed when only patients without prior nasal Staphylococcus aureus carriage were included in the analysis (log rank score 6.33, P=0.01). Median catheter survival was also significantly longer in the mupirocin group (108 vs 31 days, log rank score 5.9, P<0.05). Mupirocin use was not associated with any adverse patient effects or the induction of antimicrobial resistance.

Conclusions. Thrice-weekly application of mupirocin to tunnelled, cuffed haemodialysis catheter exit sites is associated with a marked reduction in line-related sepsis and a prolongation of catheter survival.
Keyword Transplantation
Urology & Nephrology
Antibiotics Therapeutic Use
Bacteraemia
Catheterization, Central Venous
Dialysis
Equipment Contamination
Staphylococcal Infections
Staphylococcus-aureus
Hemodialysis-patients
Nasal Carriage
Infection
Access
Ointment
Sepsis
Q-Index Code C1
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: Faculty of Health and Behavioural Sciences -- Publications
Excellence in Research Australia (ERA) - Collection
 
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Created: Wed, 15 Aug 2007, 03:48:56 EST