“Pulse” Nasal Mupirocin Maintenance Regimen in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

1999 ◽  
Vol 20 (11) ◽  
pp. 741-745 ◽  
Author(s):  
Joseph M. Mylotte ◽  
Lucinda Kahler ◽  
Ellen Jackson
Keyword(s):  
Peritoneal Dialysis ◽  
Adverse Effects ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Site Infection ◽  
Infection Rates ◽  
Exit Site ◽  
Exit Site Infection ◽  
Nasal Mupirocin ◽  
The Mean

AbstractObjective:To determine, among patients undergoing continuous ambulatory peritoneal dialysis (CAPD) who wereStaphylococcus aureusnasal carriers, if periodic brief “pulses” of nasal mupirocin calcium ointment 2% after completion of a mupirocin eradication protocol would maintain these patients free of carriage.Design:Noncomparative, nonblinded study with historical controls.Setting:A county medical center.Patients:Patients in a CAPD program during the period April 1996 to May 1998.Methods:All patients in the CAPD program had monthly nasal cultures forS aureus. After informed consent,S aureusnasal carriers were administered mupirocin to the nares twice a day for 5 days followed by nasal mupirocin twice monthly. Peritonitis and exit-site infection rates were monitored independently by CAPD nursing staff. Patients were monitored monthly for adverse effects of mupirocin and compliance with the maintenance regimen.Results:Twenty-four patients in the CAPD program were enrolled in the study and had a median duration of follow-up of 8.5 months. Fifteen (63%) of the 24 patients remained free of nasal carriage on follow-up cultures. Of the 9 patients with positive nasal cultures during the study, 8 had only one positive culture. There was no significant difference in the mean yearly peritonitis rate orS aureusperitonitis rate (January 1995-May 1998). However, there was a significant decrease in the mean yearly exit-site infection rates both overall (from 8.8 episodes per 100 patients dialyzed per month in 1995 to 4.0 in 1998;P=.008) and due toS aureus(from 5.6 in 1995 to 0.9 in 1998;P=.03). Adverse effects of nasal mupirocin were mild overall; 1 patient was removed from the study due to an allergic reaction to mupirocin.Conclusions:Among CAPD patients who wereS aureusnasal carriers, periodic brief treatment with nasal mupirocin after an initial eradication regimen kept them free of carriage, for the most part, with few adverse effects. The pulse mupirocin regimen offers simplicity and possibly better compliance, as well as minimizing exposure to this agent, thereby possibly reducing the risk of resistance. Further studies are warranted to compare this regimen to other commonly used mupirocin maintenance regimens in dialysis patients.

Continuous Ambulatory Peritoneal Dialysis in Egypt: Progression despite Handicaps

2010 ◽  
Vol 30 (3) ◽  
pp. 269-273 ◽  
Author(s):  
Khaled M. Mahmoud ◽  
Hussein A. Sheashaa ◽  
Osama A. Gheith ◽  
Ehab W. Wafa ◽  
Amgad E. Agroudy ◽  
...  
Keyword(s):  
Developing Countries ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Infection Rates ◽  
Exit Site ◽  
Exit Site Infection ◽  
Biochemical Assessment ◽  
And Training ◽  
Culture Negative

♦ BackgroundDespite the well-known advantages of continuous ambulatory peritoneal dialysis (CAPD), it continues to be grossly underutilized in many developing countries. However, some developing countries, such as Mexico, use the modality very effectively. In view of this, we started the first CAPD program in Egypt.♦ MethodsSince its start in 1997, our program has treated 33 patients. Straight double-cuffed Tenckhoff catheters were surgically placed in all patients. Twin-bag systems were used. All patients underwent monthly clinical and biochemical assessment and measurement of Kt/V urea. Peritonitis and exit-site infection rates were monitored.♦ ResultsMost treated patients were adult and female. Mean age was 31.7 years and mean follow-up duration was 18 months. Peritonitis rate was 1 episode /21.3 months and was easily managed in most patients. Staphylococcus aureus was the most commonly isolated organism (24%) but 49% of cases were culture negative. There were no exit-site infections. Mean weekly Kt/V urea was 1.78 ± 0.23.♦ ConclusionWe report the successful development of a small CAPD program in Egypt, made possible by well-established financial support, a motivated team of doctors and nurses, and good patient selection and training.

scholarly journals Twin- versus single-bag disconnect systems: infection rates and cost of continuous ambulatory peritoneal dialysis.

1996 ◽  
Vol 7 (11) ◽  
pp. 2392-2398 ◽  
Author(s):  
D C Harris ◽  
E J Yuill ◽  
K Byth ◽  
J R Chapman ◽  
C Hunt
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Randomized Study ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Total Cost ◽  
Purchase Cost ◽  
Fluid Transfer

Although twin-bag disconnect fluid-transfer systems for continuous ambulatory peritoneal dialysis (CAPD) have a lower rate of catheter-related infection than single-bag systems, their greater monetary purchase cost has prevented universal adoption. Therefore, a single-center randomized study was performed in 63 adult patients to compare the efficiency and total cost of Freeline Solo (FS, twin-bag) and Basic Y (BY, single-bag) systems. Patients were new to CAPD (N = 39), or had a new CAPD catheter, or had had no episodes of peritonitis or exit-site infection in the previous 12 months (N = 24). Total follow-up was 631 patient months (pt.mon), and 53 patients were still on the trial at its termination. Patients rated FS as easier to use than BY (P < 0.001). Peritonitis occurred on 23 occasions in 12 out of 30 patients using BY, and on seven occasions in five of 33 patients using FS. Time to first infection was less with BY than FS (hazard ratio, 2.4; 95% confidence interval (CI), 1.0 to 5.3; P < 0.04). Cumulative incidence of peritonitis was 1 per 14.0 pt.mon with BY and 1 per 46.5 pt.mon with FS (odds ratio, 3.6; 95% CI 1.5 to 8.5; P = 0.004). Length of hospitalization for peritonitis or exit-site infection was 98 days in six patients with BY, versus 17 days in two patients with FS. With BY, four catheters were removed because of infection, but none with FS (P < 0.05). With BY, the total cost of infection was $AUD127,079 ($5033 per pt.yr) versus $19,250 ($704 per pt.yr) with FS, which offset the higher purchase cost of FS. The total cost of CAPD was $AUD956 per pt.yr less with FS than BY. In conclusion, the higher purchase cost of the FS twin-bag system is more than offset by savings from its lower incidence of peritonitis.

scholarly journals Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. Mupirocin Study Group.

1996 ◽  
Vol 7 (11) ◽  
pp. 2403-2408
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Treatment Group ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Nasal Carriage ◽  
Control Group ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Nasal Mupirocin

A total of 1144 patients receiving continuous ambulatory peritoneal dialysis in nine European centers was screened for nasal carriage of Staphylococcus aureus. Two hundred sixty-seven subjects were defined as carriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal ointment twice daily for 5 consecutive days every 4 wk. The treatment group used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Welwyn Garden City, United Kingdom) and the control group used placebo ointment. Patients were followed-up for a maximum period of 18 months. There were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic data, cause of renal failure, type of catheter, system used, or method of exit-site care between the groups. Similarly, there were no differences in patient outcome or incidence of adverse events between both groups. Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group and 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin group and 44 in the control group (P = 0.006, mixed effects Poisson regression model). There were no differences in the rate of tunnel infection or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carriers of S. aureus significantly reduces the rate of exit-site infections that occurs because of this organism.

scholarly journals 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

2015 ◽  
Vol 35 (7) ◽  
pp. 712-721 ◽  
Author(s):  
Lei Zhang ◽  
Sunil V. Badve ◽  
Elaine M. Pascoe ◽  
Elaine Beller ◽  
Alan Cass ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Site Infection ◽  
Control Groups ◽  
Exit Site ◽  
Exit Site Infection ◽  
Gram Negative ◽  
Nasal Mupirocin ◽  
And Control ◽  
Technique Failure ◽  
Culture Negative

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.

Comparison of Exit -Site Infections in Disconnect versus Nondisconnect Systems for Peritoneal Dialysis

1992 ◽  
Vol 12 (3) ◽  
pp. 317-320 ◽  
Author(s):  
John M. Burkart ◽  
Jean R. Jordan ◽  
Theresa A. Durnel ◽  
L. Douglas Case
Keyword(s):  
Peritoneal Dialysis ◽  
Marked Reduction ◽  
Site Infection ◽  
Automated Peritoneal Dialysis ◽  
Infection Rates ◽  
Exit Site ◽  
Endstage Renal Disease ◽  
Exit Site Infection ◽  
Dialysis Unit ◽  
Private Setting

Objective To determine if disconnect systems reduce the incidence of exit-site infections when compared to nondisconnect systems. Design We prospectively monitored exit-site infections and peritonitis rates in 96 disconnect patients (Yset, automated peritoneal dialysis (APD)) and 60 nondisconnect patients (spike, ultraviolet connection device (UVXD)). Setting A freestanding chronic peritoneal dialysis unit staffed by physicians from both a medical school and a private setting. Patients All patients who began peritoneal dialysis at our unit were monitored, regardless of cause of endstage renal disease (ESRD) or age. Intervention Patients were dialyzed using the system (Y-set, spike, etc.) most appropriate for their life-style and their ability to administer self-care. Main Outcome We attempted to follow disconnect and nondisconnect patients for a similar median time on dialysis and compared differences in exit-site infections. Results Peritonitis rates (episodes/pt year) were reduced for disconnect (0.60) versus nondisconnect (0.99) systems (p=0.0006). Despite the marked reduction in peritonitis rates, there was no difference in exit-site infection rates (0.35 vs 0.38), the time to the first exit -site infection, or the time to the first catheter removal for disconnect versus nondisconnect groups. When individual systems were compared, differences in exit-site infection rates (episodes/pt years) were noted (0.62, spike; 0.26,UVXD; 0.32,Y-set; 0.41,APD). Conclusion We found no overall difference in exit site infection rates for disconnect versus nondisconnect systems, despite a reduction in peritonitis rates for disconnect systems.

Peritonitis in Continuous Ambulatory Peritoneal Dialysis {CAPD): A Multi-Centre Randomized Clinical Trial Comparing the Y Connector Disinfectant System to Standard Systems

1989 ◽  
Vol 9 (3) ◽  
pp. 159-163 ◽  
Author(s):  
◽  
O.N. Churchil ◽  
O.W. Taylor ◽  
S.I. Vas ◽  
O.G. Oreopoulos ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Peritoneal Dialysis ◽  
Risk Reduction ◽  
Randomized Clinical Trial ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Standard Group ◽  
Site Infection ◽  
Confidence Limits ◽  
Exit Site ◽  
Exit Site Infection

sixty-one new continuous ambulatory peritoneal dialysis (CAPD) patients were allocated to a Y connector disinfectant (Amuchina, Italy) and 63 to standard systems (Baxter Systems II & III) in a randomized clinical trial addressing peritonitis rates in 8 CAPD programs in 6 Canadian cities. In the Y connector-disinfectant group, 15 patients experienced 21 episodes of peritonitis in 452 patient-months or 1 per 21.53 patient-months. In the standard systems group, 30 patients experienced 47 episodes of peritonitis in 467 patient-months or 1 per 9.93 patient-months ( p = 0.009). The peritonitis risk reduction was 61% (95% confidence limits 27–79%). Exit-site infections occurred in 36% of each group. Prior to the development of exit -site infection, the monthly risk for peritonitis was 3.12% for the Y connector disinfectant system and 7.37% for the standard system. After an exit -site infection, these probabilities increased to 6.15% and 15.47%, respectively. Skin organisms were responsible for peritonitis in 8/21 (38%) in the Y connector-disinfectant group and 30/47 (64%) in the standard group. There were 75 days hospitalized for peritonitis in the Y connector-disinfectant group compared to 257 days for the standard group. The Y connector disinfectant system decreases the peritonitis rate through its effect on skin organisms. Exit -site infections are a major source of organisms responsible for peritonitis.

Prophylaxis against Gram-Positive Organisms Causing Exit-Site Infection and Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients by Applying Mupirocin Ointment at the Catheter Exit Site

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 153-158 ◽  
Author(s):  
Sunny S.H. Wong ◽  
Kwok Hong Chu ◽  
Au Cheuk ◽  
Wai Kay Tsang ◽  
Samuel K.S. Fung ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Local Application ◽  
Diabetic Patients ◽  
Site Infection ◽  
Dialysis Patients ◽  
Exit Site ◽  
Gram Positive ◽  
Exit Site Infection ◽  
Mupirocin Ointment

Objective We evaluated the effectiveness of local application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis attributable to gram-positive organisms in continuous ambulatory peritoneal dialysis patients. Methods This prospective randomized controlled trial included 154 patients. They were randomly allocated to a mupirocin-treated group (group M) and a control group (group C). Group M included 73 patients (47.4%) who were instructed to apply mupirocin ointment to the catheter exit site once daily after the routine daily exit-site dressing. Group C included 81 patients (52.6%) who continued their usual daily exit-site care without applying mupirocin. The two groups were followed to see whether there would be any difference in the frequency of exit-site infection and peritonitis or in the infecting organisms. Results Interim data were collected at 5 months after the start of the study. Those data showed a significantly lower incidence of exit-site infection and peritonitis attributable to gram-positive organisms in group M as compared with group C. The incidence of gram-positive exit-site infection in group C was 1 episode per 36.8 patient–months; in group M, the incidence was 1 episode per ∞ patient–months (0 incidence in 5 months, p < 0.05). The incidence of gram-positive peritonitis in group C was 1 episode per 40.5 patient–months; in group M, the incidence was 1 episode per 365 patient–months ( p < 0.05). Mupirocin treatment had no significant effect on the incidence of exit-site infection and peritonitis attributable to other organisms. Before mupirocin treatment, we saw a trend toward higher infection rates in diabetic patients and nasal carriers of Staphylococcus aureus as compared with non diabetic patients and nasal non carriers, although the differences were not statistically significant. Mupirocin brought the infection rate attributable to gram-positive organisms to an equally low level in diabetic and non-diabetic patients, and in nasal carriers and nasal non carriers of S. aureus. No adverse effect of local application of mupirocin was reported. Conclusion Local application of mupirocin ointment at the catheter exit site is a safe and effective method of preventing exit-site infection and peritonitis involving gram-positive organisms.

Comparison of Peritonitis Rates during Long Term Use of Standard Spike versus Ultraset in Continuous Ambulatory Peritoneal Dialysis (CAPD)

1990 ◽  
Vol 10 (1) ◽  
pp. 41-43 ◽  
Author(s):  
John M. Burkart ◽  
Britta Hylander ◽  
Theresa Durnell-Figel ◽  
Denise Roberts
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
First Episode ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
The Impact

Continuous ambulatory peritoneal dialysis (CAPD) is an increasingly popular means of end-stage renal disease replacement therapy. Unfortunately, peritonitis continues to be a major source of both morbidity and mortality. The Ultraset incorporates a “flush-before-fill” concept which should theoretically decrease peritonitis rates when compared to the standard spike procedure, while allowing patients the convenience of disconnect. To investigate the impact of long-term use of the Ultraset on peritonitis rates, we conducted the following study. We prospectively compared 21 new CAPD patients using the standard spike to 20 new CAPD patients using the Ultraset. Peritonitis episodes, episodes of exit -site infection, and the association of peritonitis with exit-site infection were monitored. Peritonitis rates were 7.57 months/episode for the group using the standard spike vs. 27.79 months/episode in the group using the Ultraset. Exit-site infection rates were 22.21 months/infection with the standard spike vs. 37.05 months/infection with the Ultraset. Using Kaplan-Meier plots, there was a statistically significant difference in the estimated time to the first episode of peritonitis, but there was no statistically significant difference regarding the risk of exit-site infections.

Natural History of Exit-Site Infection (ESI) in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)

1988 ◽  
Vol 8 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Georgi Abraham ◽  
Evgeije Savin ◽  
Anthony Ayiomamitis ◽  
Sharron Izatt ◽  
Stephen I. Vas ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Staph Aureus ◽  
Serous Discharge ◽  
History Of ◽  
One Year ◽  
Esi Group

One hundred and thirty-one patients were started on continuous ambulatory peritoneal dialysis (CAPD) between January 1984 and June 1987. They ranged in age from 14 to 82 years (mean 52.8). Sixty patients (1914 patient months) developed 133 episodes of exit-site infection (ESI), an incidence of one episode per 14.4 patient months. Sixty-six episodes were purulent and 67 were nonpurulent (redness, crust, or serous discharge). In diminishing order of frequency, the bacteria isolated were Staph. aureus, Staph. epidermidis, Pseudomonas, and diphtheroids. The probability for remaining free of ESI was 54% at one year and 22% at three years. Factors like single or double-cuff catheters, diabetes, and sex did not influence the development of ESI. Recurrence was common especially in purulent ESI, and medical or surgical treatment did not eradicate the infection. Patients with purulent ESI had a higher incidence of peritonitis than those with no ESI-one episode per 8.1 patient months vs. one episode per 20.9 patient months. In the ESI group, of the 154 catheters implanted, 24 (15.6%) were removed; five were lost without ESI (3%). The main cause leading to catheter removal in the ESI group were Staph. aureus and Pseudomonas infections. Peritonitis following ESI was not necessarily due to the organisms isolated from the ESI.

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