The objective of this study was to evaluate the effectiveness of
mupirocin on Staphylococcus aureus with regard to
peritoneal dialysis (PD)-
catheter exit-site
infections (ESI), tunnel
infections (TI), and
peritonitis episodes (PE). The study was performed on 42
continuous ambulatory peritoneal dialysis (
CAPD) patients (group I) treated from April 1998 to July 1999. These patients were instructed to apply
mupirocin daily at the
catheter exit site as part of their exit-site care. The control was the same group's historical
infection data. Results were also recorded for a second group of 16 patients (group II) with newly implanted PD
catheters were also instructed to apply
mupirocin at the exit site daily. During the control period (before daily
mupirocin application), group I recorded 16 episodes of ESI (0.30 episodes per patient-year), 6 episodes of TI (0.11 episodes per patient-year), 15 episodes of PE (0.28 episodes per patient-year), and one case of
catheter removal (0.019 episodes per patient-year) owing to S. aureus exit-site
infection coexisting with
peritonitis. The rate of S. aureus exit-site
infection during this period was 0.11 episodes per patient-year; of S. aureus tunnel
infection, 0.057 episodes per patient-year; and of S. aureus
peritonitis, 0.076 episodes per patient-year. During the
mupirocin period,
infections and
peritonitis owing to S. aureus dramatically decreased (p < 0.01 and p < 0.001 respectively). The rate of S. aureus exit-site
infection was 0.02 episodes per patient-year, with no S. aureus tunnel
infections, and no
catheter removals owing to S. aureus
peritonitis. Similarly, in group II, no episodes were recorded of any ESI, TI, or PE owing to S. aureus, although 4 episodes of ESI (0.37 episodes per patient-year, 2 with other gram-positive bacteria, and 2 with gram-negative bacteria) and 8 PEs (0.75 episodes per patient-year) were seen. We conclude that
mupirocin application provides excellent prophylaxis for
catheter-related infections owing to S. aureus, and that reduction of these
infections may improve the long-term survival of patients on
CAPD.