Structured literature synthesis.
METHODS: Relevant studies were identified by MEDLINE search, from personal files, and from the reference lists of retrieved articles. We analyzed English-language studies on treatment targeted at S. aureus, with at least 10 subjects and at least 3 months of follow-up, and data on staphylococcal
peritoneal dialysis catheter infections. We excluded noncontrolled studies. Two investigators abstracted data using a structured form.
RESULTS: We evaluated six studies with concurrent controls and eight studies with historical controls. In one randomized, placebo-controlled, blinded study, periodic nasal
mupirocin ointment reduced the rate of staphylococcal exit-site
infection from 0.42 to 0.12 episodes/patient-year (p = 0.006), but had no effect on the rates of staphylococcal tunnel
infection,
peritonitis, or
catheter loss. In one randomized study without placebo control, periodic oral
rifampin reduced the rate of staphylococcal exit-site
infection from 0.65 to 0.22 epi/pt-yr (p = 0.011), but had no effect on the rate of staphylococcal
peritonitis. In another nonblinded, randomized, controlled study, the use of either
rifampin or
mupirocin was associated with low rates of staphylococcal
catheter infections and
catheter loss. In one study with historical controls, the rate of staphylococcal exit-site
infection and
peritonitis was lower after oral
rifampin prophylaxis. In seven other studies comparing nasal or exit-site
mupirocin to historical controls, the rate of staphylococcal exit-site
infection decreased from 0.17 to 0.05 epi/pt-yr, the rate of staphylococcal
peritonitis decreased from 0.18 to 0.06 epi/pt-yr, and the rate of
catheter loss decreased from 0.09 to 0.05 epi/pt-yr during the
mupirocin period.
CONCLUSION: The literature provides strong evidence that staphylococcal carriage prophylaxis using either oral
rifampin or
mupirocin ointment in the nares or exit site reduces significantly the rate of exit-site
infection due to Staphylococcus aureus. Weaker evidence based on studies with historical controls suggests that
rifampin or
mupirocin prophylaxis also reduces the rate of staphylococcal
peritonitis and peritoneal
catheter loss. Studies with a stronger level of evidence are needed to verify this last point.