The MP3 Study: Mupirocin Tops Polysporin for PD Infection Prophylaxis

By Peter Laird, MD

Patients undergoing peritoneal dialysis (PD) are prone to peritonitis as well as exit site infections (ESI) from various organisms. Unfortunately, PD related infections is one of the limiting factors in the effectiveness of peritoneal dialysis with most patients experiencing at least one episode of peritonitis annually. The most common pathogens are those that grow on the skin called gram positive bacteria. These are bacteria that stain dark when placed in Gram's dark stain. The most virulent skin organism in these infections is Staph Aureus which many people carry in there nose. Several prior studies have shown that Mupirocin (Bactroban) is an effective antibiotic for preventing ESI and peritonitis in PD patients. The MP³ Study compared Polysporin triple anibiotic (P³) to Mupirocin:

A Randomized Controlled Trial Comparing Mupirocin and Polysporin Triple Ointments in Peritoneal Dialysis Patients: The MP³ Study

Results Seventy-five of 201 randomized patients experienced a primary outcome event (51 peritonitis episodes, 24 ESIs). No difference was seen in the time to first event for P³ (13.2 months; 95% confidence interval, 11.9–14.5) and mupirocin (14.0 months; 95% confidence interval, 12.7–15.4) (P=0.41). Twice as many patients reported redness at the exit site in the P³ group (14 versus 6, P=0.10). Over the complete study period, a higher rate per year of fungal ESIs was seen in patients using P³ (0.07 versus 0.01; P=0.02) with a corresponding increase in fungal peritonitis (0.04 versus 0.00, respectively; P<0.05).

Conclusions This study shows that P³ is not superior to mupirocin in the prophylaxis of PD-related infections. Colonization of the exit site with fungal organisms is of concern and warrants further study. As such, the use of P³ over mupirocin is not advocated in the prophylaxis of PD-related infections.

There are many techniques useful in mitigating the risk of infection including careful hand washing, wear gloves when changing bandages, check the tubing for any signs of cracks daily as well as observing any redness or discharge from the PD tunnel, and avoiding hot tubs and public pools. Placing antibiotic creams are effective. When compared to Polysporin, Mupirocin is more effective at preventing PD related infections.

Comments

[Ravi]

Please see this great article in HBR on Mobile PD Disease Management.

http://blogs.hbr.org/cs/2012/04/how_telemedicine_saves_lives_a.html

It solves the biggest limiting factor in the adoption of PD - peritonitis as well as exit site infections (ESI) from various organisms.

This is a classic case of Reverse Innovation and the US health care system and the various stakeholders - CMS, private insurance, providers, patients, care givers, drug and device makers, EMR vendors etc. - are in dire need of smart medicine