Journal article
Effect of Preventing Staphylococcus Aureus Carriage on Rates of Peritoneal Catheter-Related Staphylococcal Infections. Literature Synthesis
Peritoneal dialysis international, Vol.21(5), pp.471-479
09/2001
DOI: 10.1177/089686080102100508
PMID: 11757831
Abstract
Objective To determine whether specific preventive measures reduce the rate of peritoneal catheter-related infections and peritoneal catheter loss due to Staphylococcus aureus. Design 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 W e 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.
Details
- Title: Subtitle
- Effect of Preventing Staphylococcus Aureus Carriage on Rates of Peritoneal Catheter-Related Staphylococcal Infections. Literature Synthesis
- Creators
- Jennifer Ritzau - General Internal Medicine Section, and Renal Section, New Mexico VA Health Care System, and Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.ARichard M Hoffman - General Internal Medicine Section, and Renal Section, New Mexico VA Health Care System, and Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.AAntonios H Tzamaloukas - General Internal Medicine Section, and Renal Section, New Mexico VA Health Care System, and Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
- Resource Type
- Journal article
- Publication Details
- Peritoneal dialysis international, Vol.21(5), pp.471-479
- DOI
- 10.1177/089686080102100508
- PMID
- 11757831
- ISSN
- 0896-8608
- eISSN
- 1718-4304
- Language
- English
- Date published
- 09/2001
- Academic Unit
- Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094758102771
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