Topical gentamicin is superior to mupirocin for prophylaxis against gram-negative bacterial infections among patients on peritoneal dialysis (PD), according to a new systematic review and meta-analysis.
Mupirocin, a polyketide antibiotic produced by Pseudomonas fluorescens, is the current standard of care in most centers and has proven effective against gram-positive organisms. There has been a recent rise in gram-negative infections, however.
“In our opinion, gentamicin cream may be a better option for centers with a relatively high incidence of gram-negative exit-site infection or peritonitis,” Shih-Ping Cheng, MD, PhD, of Mackay Medical College in Taiwan, and colleagues wrote in a paper published online ahead of print in the American Journal of Surgery. Gram-negative infections may follow touch contamination, such as from a bowel source. Peritonitis from gram-negative bacteria often leads to hospitalization, catheter loss, and failure of PD, according to background information in the paper.
The investigators assessed the risk of exit-site infections in a meta-analysis of 7 studies involving 458 patients treated with mupirocin and 448 treated with gentamicin. They found that the risk of exit-site infections from gram-positive organisms was similar between groups. Gram-negative exit-site infections, however, occurred at a higher rate among mupirocin patients. Patient age averaged in the 50s.
The investigators found no difference in the gram-positive and gram-negative peritonitis rate based on an analysis of 6 studies involving 397 mupirocin and 388 gentamicin patients. Peritonitis can arise after an exit-site infection. One episode of peritonitis might occur normally every 18 months (or 0.67 episodes per year), according to the researchers.
“Gentamicin may also be considered for those with a high incidence of exit-site infections caused by gram-positive organisms other than S. aureus,” Dr Cheng and the team added. “Conversely, mupirocin is more favorable when the institutional incidence and prevalence rates of S. aureus infections are high.”
1. Tsai CC, Yang PS, Liu CL, Wu CJ, Hsu YC, Cheng SP. Comparison of topical mupirocin and gentamicin in the prevention of peritoneal dialysis-related infections: A systematic review and meta-analysis. Am J Surg. March 16, 2017 [Epub ahead of pint]