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“Pulse” Nasal Mupirocin Maintenance Regimen in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Published online by Cambridge University Press:  02 January 2015

Joseph M. Mylotte ,
Lucinda Kahler  and
Ellen Jackson
Joseph M. Mylotte*
Affiliation:
Departments of Medicine and Microbiology, the School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, Buffalo, New York Department of Medicine, Erie County Medical Center, Buffalo, New York
Lucinda Kahler
Affiliation:
Department of Medicine, Erie County Medical Center, Buffalo, New York
Ellen Jackson
Affiliation:
Department of Medicine, Erie County Medical Center, Buffalo, New York
*
Infectious Diseases, Erie County Medical Center, 462 Grider St, Buffalo, NY 14215
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Abstract

Objective:

To determine, among patients undergoing continuous ambulatory peritoneal dialysis (CAPD) who were Staphylococcus aureus nasal carriers, if periodic brief “pulses” of nasal mupirocin calcium ointment 2% after completion of a mupirocin eradication protocol would maintain these patients free of carriage.

Design:

Noncomparative, nonblinded study with historical controls.

Setting:

A county medical center.

Patients:

Patients in a CAPD program during the period April 1996 to May 1998.

Methods:

All patients in the CAPD program had monthly nasal cultures for S aureus. After informed consent, S aureus nasal carriers were administered mupirocin to the nares twice a day for 5 days followed by nasal mupirocin twice monthly. Peritonitis and exit-site infection rates were monitored independently by CAPD nursing staff. Patients were monitored monthly for adverse effects of mupirocin and compliance with the maintenance regimen.

Results:

Twenty-four patients in the CAPD program were enrolled in the study and had a median duration of follow-up of 8.5 months. Fifteen (63%) of the 24 patients remained free of nasal carriage on follow-up cultures. Of the 9 patients with positive nasal cultures during the study, 8 had only one positive culture. There was no significant difference in the mean yearly peritonitis rate or S aureus peritonitis rate (January 1995-May 1998). However, there was a significant decrease in the mean yearly exit-site infection rates both overall (from 8.8 episodes per 100 patients dialyzed per month in 1995 to 4.0 in 1998; P=.008) and due to S aureus (from 5.6 in 1995 to 0.9 in 1998; P=.03). Adverse effects of nasal mupirocin were mild overall; 1 patient was removed from the study due to an allergic reaction to mupirocin.

Conclusions:

Among CAPD patients who were S aureus nasal carriers, periodic brief treatment with nasal mupirocin after an initial eradication regimen kept them free of carriage, for the most part, with few adverse effects. The pulse mupirocin regimen offers simplicity and possibly better compliance, as well as minimizing exposure to this agent, thereby possibly reducing the risk of resistance. Further studies are warranted to compare this regimen to other commonly used mupirocin maintenance regimens in dialysis patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 11 , November 1999 , pp. 741 - 745
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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