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Topical Mupirocin/Sodium Hypochlorite Reduces Peritonitis and Exit-Site Infection Rates in Children

Annabelle N. Chua^*, Stuart L. Goldstein^*, Deborah Bell, and Eileen D. Brewer^*

^* Department of Pediatrics, Renal Division, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas; and Texas Children’s Hospital, Dialysis Unit, Houston, Texas

Correspondence: Dr. Annabelle N. Chua, Department of Pediatrics, Renal Division, 6621 Fannin Street, MC 3-2482, Houston, TX 77030. Phone: 832-824-3800; Fax: 832-825-3889; E-mail: anchua{at}texaschildrenshospital.org

Background and Objectives: Peritoneal dialysis (PD) is a common maintenance renal replacement modality for children with ESRD frequently compromised by infectious peritonitis and catheter exit site and tunnel infections (ESI/TI). The effect of topical mupirocin (Mup) and sodium hypochlorite (NaOCl) solution was evaluated as part of routine daily exit site care on peritonitis and ESI/TI rates, causative microorganisms, and catheter survival rates.

Design, setting, participants, & measurements: Retrospective chart review of children on home continuous cycling PD between April 1, 2001 and June 30, 2007 was performed. Infection rates were examined based on exit site protocol used in two different periods: Mup alone, April 1, 2001 to November 17, 2004; and Mup and NaOCl (Mup+NaOCl), November 18, 2004 to June 30, 2007.

Results: Eighty-three patients (mean PD initiation age: 12.1 ± 5.8 yr) received home PD over 2009 patient months. Annualized rates (ARs) for peritonitis decreased from 1.2 in the Mup period to 0.26 in the Mup+NaOCl period (P < 0.0001). ARs for ESI/TI decreased from 1.36 in the Mup period to 0.33 in the Mup+NaOCl period (P < 0.0001). No infections with Mup-resistant organisms were observed when either Mup or Mup+NaOCl was used for prophylaxis. Gram-negative-organism associated peritonitis decreased from an AR of 0.31 in the Mup period to 0.07 in the Mup+NaOCl period (P < 0.001). Infection-related catheter removal rates decreased from 1 in 38.9 catheter-months in the Mup period to 1 in 94.2 in the Mup+NaOCl period (P = 0.01). Catheter survival rates were longer in the Mup+NaOCl period (Kaplan–Meier, P < 0.009).

Conclusions: The combination Mup+NaOCl in daily exit site care was very effective to reduce PD catheter-associated infections and prolong catheter survival in pediatric patients.