Mupirocin for preventing exit-site infection and peritonitis in patients undergoing peritoneal dialysis

Objectives. Recently, there have been increasing concerns about the emergence of mupirocin resistance and increased infections due to lowered inhibition of Staphylococcus aureus. We conducted this systemic analysis to find out whether the application of mupirocin was effective for the prevention of exit-site infection (ESI) and peritonitis in patients undergoing peritoneal dialysis (PD). Methods. Recruited studies met the following criteria: they were randomized controlled trials or historical cohort studies; subjects consisted of adults (age, >= 18 years) undergoing PD; mupirocin treatment was administered to the therapy group and placebo or no treatment was administered to the control group. The primary extracted data were the difference in the episodes of ESI and peritonitis S. aureus or other organisms among treatment and control groups. Results. Fourteen studies described in 13 articles and a total of 1233 patients versus 1217 controls were included in the analysis. Of the 13 articles, 6 were newly published articles that had not been analysed previously and 3 were randomized controlled trials. The application of mupirocin decreased the risk by 72% [95% confidence interval (CI): 0.60-0.81] in ESI and by 70% (95% CI 0.52-0.81) in peritonitis due to S. aureus among all patients undergoing PD. Treatment of mupirocin reduced the risks of ESI and peritonitis due to all organisms by 57% (95% CI: 0.46-0.66) and 41% (95% CI: 0.24-0.54), respectively. Based on the six newly published articles, the reduced risk rate for mupirocin therapy was found to be 80% (95% CI: 0.39-0.93, P = 0.004) in ESI and 91% (95% CI: 0.72-0.97, P < 0.0001) in peritonitis due to S. aureus; 70% (95% CI: 0.47-0.82, P < 0.0001) in ESI and 42% (95% CI: 0.25-0.55, P < 0.0001) in peritonitis due to all organisms among mupirocin-treated and -untreated subjects. Based on the three randomized controlled trials, ESI and peritonitis due to S. aureus were found to be reduced by 73% (95% CI: 0.63-0.80, P < 0.0001) and 40% (95% CI: 0.17-0.56, P = 0.002), respectively. Interestingly, although mupirocin treatment can reduce the risk rate of ESI by 46% (95% CI: 0.35-0.55, P < 0.00001), it cannot decrease the risk rate of peritonitis due to all organisms (P = 0.56). Conclusions. Mupirocin prophylaxis was effective on preventing ESI and peritonitis due to S. aureus and other organisms in PD patients.