Saudi Journal of Kidney Diseases and Transplantation (Jan 2008)
Prevention of Staphylococcal Peritonitis in CAPD Patients Combining Ablution and Mupirocin
Abstract
Although there has been a dramatic decrease in the incidence of peritonitis in continuous ambulatory peritoneal dialysis (CAPD), rates > 0.5 episodes per patient per year are still common, with a very high rate of relapse. The nasal, pharyngeal, and skin carriage of Staphylococcus aureus (S. aureus) has been reported to be one of the most important of predisposing factors for peritonitis. Mupirocin application has been introduced to combat S. aureus carriage state with some degree of success. To evaluate the benefits of combining ablution for prayers with mupirocin in eliminating the carrier state of S. aureus and thus preventing peritonitis in CAPD patients, we randomized prospectively 65 patients on CAPD into two groups; group (1) used mupirocin intranasal application alone, and group (2) were instructed, in addition to application of mupirocin, to perform the proper ablution technique. The main outcome measures were the state of nasal, skin and pharyngeal S. aureus carriage state, the incidence of peritonitis, and mal-function-free PD catheter survival. After 3 months of CAPD initiation, S. aureus carrier state was detected in 11 (33.3%) patients in group (1), and in 2 (6.25%) patients in group (2) (p< 0.005), and at the end of the study 10 (30.3%) patients from group (1) and none in group (2) remained S. aureus carriers (p< 0.001). S. aureus peritonitis occurred in 19 occasions in 10 patients of group (1) versus 4 occasions in 3 patients of group (2) (p< 0.001). Malfunction-free catheter survival at 12 months was 72.7% in group (1) versus 90.6% in group (2) patients (p< 0.05). We conclude that combined with mupirocin intranasal application, performing proper ablution is an effective measure against S aureus carriage and hence it decreases the incidence of continuous ambulatory peritoneal dialysis-associated S. aureus peritonitis.
