Abstract
Background
The International Society for Peritoneal Dialysis guidelines recommends the topical application of antibiotics on the exit site for the prevention of peritoneal dialysis (PD)-related infections. However, the recommendation is based on meta-analyses on applying nasal mupirocin ointment or observational or retrospective studies. Here, we evaluated the efficacy of topical application of mupirocin on the exit site for the prevention of PD-related infections.
Methods
We searched the databases, MEDLINE and CENTRAL, documenting the topical application of antibiotics on the exit site in PD patients in April 2017. We included only randomized controlled trials (RCTs) with adult patients wherein the effects of mupirocin were examined. Exit site infection (ESI), peritonitis, and technical failure were assessed as the main outcomes.
Results
Overall, six RCTs were included in this study. It was uncertain whether the application of mupirocin ointment prevents ESI (rate ratio (RR), 0.36; 95% CI, 0.13–1.05), peritonitis (RR 0.78, 95% CI 0.50–1.21), and technical failure (RR, 1.35; 95% CI, 0.25–7.21). Moreover, a comparison between mupirocin and gentamicin showed no difference in the incidence of ESI (RR, 1.14; 95% CI, 0.27–4.81), peritonitis (RR, 0.85; 95% CI, 0.32–2.26), and technical failure (RR, 0.58; 95% CI, 0.28–1.20).
Conclusions
It remains unclear whether topical application of mupirocin on the exit site has any significant effects on PD-related infection or technical failure. Large-scale RCTs with high methodological quality are required to confirm the efficacy of topical application of antibiotics on the exit site.
Trial registration
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Details
1 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Nagasaki University Hospital, Department of Nephrology, Nagasaki, Japan (GRID:grid.411873.8) (ISNI:0000 0004 0616 1585)
2 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Nagoya City University Graduate School of Medical Sciences, Department of Nephrology, Nagoya, Japan (GRID:grid.260433.0) (ISNI:0000 0001 0728 1069)
3 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Kansai Electric Power Hospital, Department of Nephrology, Osaka, Japan (GRID:grid.414973.c)
4 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Wakayama Medical University, Department of Nephrology, Wakayama, Japan (GRID:grid.412857.d) (ISNI:0000 0004 1763 1087)
5 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Inoue Hospital, Department of Internal Medicine, Osaka, Japan (GRID:grid.414621.4) (ISNI:0000 0004 0404 6655)
6 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Kyoritsu Hospital, Department of Nephrology and Dialysis, Kawanishi, Japan (GRID:grid.458411.d)
7 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Hyogo Prefectural Amagasaki General Medical Center, Hospital Care Research Unit, Amagasaki, Japan (GRID:grid.458411.d)
8 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); National Hospital Organization Toyohashi Medical Center, Department of Oral and Maxillofacial Surgery, Toyohashi-shi, Japan (GRID:grid.458411.d)
9 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Tokyo Saiseikai Central Hospital, Division of Nephrology, Department of Internal Medicine, Tokyo, Japan (GRID:grid.270560.6) (ISNI:0000 0000 9225 8957)
10 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Aichi Medical University, Department of Nephrology and Rheumatology, Nagakute, Japan (GRID:grid.411234.1) (ISNI:0000 0001 0727 1557)
11 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Oita University Faculty of Medicine, Clinical Engineering Research Center, Yufu, Japan (GRID:grid.412334.3) (ISNI:0000 0001 0665 3553)
12 Japanese Society for Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Saitama Medical University, Department of General Internal Medicine, Saitama, Japan (GRID:grid.410802.f) (ISNI:0000 0001 2216 2631)