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. Issue 7 (December 2015)

• Record Type: Journal Article
• Authors: Zhang, Lei; Badve, Sunil V.; Pascoe, Elaine M.; Beller, Elaine; Cass, Alan; Clark, Carolyn; de Zoysa, Janak; Isbel, Nicole M.; McTaggart, Steven; Morrish, Alicia T.; Playford, E. Geoffrey; Scaria, Anish; Snelling, Paul; Vergara, Liza A.; Hawley, Carmel M.; Johnson, David W.
• Is Part Of: Peritoneal dialysis international. Volume 35:Issue 7(2015)
• Page Start: 712
• Page End: 721
• Publication Date: 2015-12
• Subjects: Honey -- peritonitis -- exit-site infection -- mupirocin -- microbiology -- hospitalization -- technique failure -- peritoneal dialysis related infection; Peritoneal dialysis -- Periodicals; Continuous ambulatory peritoneal dialysis -- Periodicals; 617.461059
• DOI: 10.3747/pdi.2014.00206
• Languages: English
• ISSNs: 0896-8608

Abstract

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.