Abstract
BackgroundThe 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.MethodsWe 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.ResultsOverall, 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).ConclusionsIt 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 registrationUMINR000039267
Highlights
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
Design and setting of the study This is a systematic review (SR) with meta-analysis that assesses whether the application of mupirocin ointment on the exit site is effective in preventing exit-site infection (ESI), peritonitis, or technical failure in PD patients
Further database search for more recent articles identified 1 Clinical practice guideline (CPG) [7] and 1 Randomized controlled trial (RCT) [17] meeting our inclusion criteria
Summary
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. The International Society for Peritoneal Dialysis (ISPD) guidelines recommended daily topical application of antibiotic agents on the exit site [7]. Among the antibiotic agents applied on the exit site, mupirocin ointment has been reported to reduce the risk of PD-related infections [8,9,10,11,12,13]. We evaluate the efficacy of topical application of mupirocin ointment on the exit site for the prevention of PD-related infection using RCTs in this systematic review (SR). We compared mupirocin with gentamicin that were reported to reduce ESI caused by gram-negative bacteria [19]
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