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.

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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.”

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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]