Alternative ointment doesn’t reduce infections in peritoneal dialysis patients

Polysporin triple ointment (P3) is not superior to mupirocin in preventing infections in peritoneal dialysis (PD) patients and may lead to an increased rate of fungal colonization, reports a trial in the Clinical Journal of the American Society of Nephrology.

The randomized controlled trial included 201 PD patients from two centers. Patients were assigned to the routine use of P3 or mupirocin ointment applied to the exit site for 18 months. A composite end point of exit-site infection (ESI), tunnel infection, or peritonitis was compared between groups.

Seventy-five patients had a primary outcome event, including 51 episodes of peritonitis and 24 ESIs. The time to first adverse outcome event was 13.2 months with P3 and 14.0 months with mupirocin. Redness at the exit site was reported by 14 patients in the P3 group versus six in the mupirocin group.

The overall rate of fungal ESIs was higher with P3 than with mupirocin: 0.07 versus 0.01 per year, respectively. This led to a fungal peritonitis rate of 0.04 per year in the P3 group, compared with no cases in the mupirocin group.

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Topical ointments can reduce the risk of peritonitis in PD patients. New alternatives are being searched for to deal with the potential problem of antimicrobial resistance.

The new trial found no reduction in infectious complications in PD patients using P3 compared with standard mupirocin ointment. The authors express concern over the possible increase in fungal colonization of the exit site with P3 ointment, and they call for further study [McQuillan RF, et al. A randomized controlled trial comparing mupirocin and polysporin triple ointments in peritoneal dialysis patients: the M P3 study. Clin J Am Soc Nephrol 2012; 7:297–303].