TY - JOUR
T1 - Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT)
T2 - A randomised trial
AU - Johnson, David W.
AU - Badve, Sunil V.
AU - Pascoe, Elaine M.
AU - Beller, Elaine
AU - Cass, Alan
AU - Clark, Carolyn
AU - de Zoysa, Janak
AU - Isbel, Nicole M.
AU - McTaggart, Steven
AU - Morrish, Alicia T.
AU - Playford, E. Geoffrey
AU - Scaria, Anish
AU - Snelling, Paul
AU - Vergara, Liza A.
AU - Hawley, Carmel M.
N1 - Copyright © 2014 Elsevier Ltd. All rights reserved.
PY - 2014/1
Y1 - 2014/1
N2 - BACKGROUND: There is a paucity of evidence to guide the best strategy for prevention of peritoneal-dialysis-related infections. Antibacterial honey has shown promise as a novel, cheap, effective, topical prophylactic agent without inducing microbial resistance. We therefore assessed whether daily application of honey at the exit site would increase the time to peritoneal-dialysis-related infections compared with standard exit-site care plus intranasal mupirocin prophylaxis for nasal carriers of Staphylococcus aureus.METHODS: In this open-label trial undertaken in 26 centres in Australia and New Zealand, participants undergoing peritoneal dialysis were randomly assigned in a 1:1 ratio with an adaptive allocation algorithm to daily topical exit-site application of antibacterial honey plus standard exit-site care or intranasal mupirocin prophylaxis (only in carriers of nasal S aureus) plus standard exit-site care (control group). The primary endpoint was time to first infection related to peritoneal dialysis (exit-site infection, tunnel infection, or peritonitis). The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12607000537459.FINDINGS: Of 371 participants, 186 were assigned to the honey group and 185 to the control group. The median peritoneal-dialysis-related infection-free survival times were not significantly different in the honey (16·0 months [IQR not estimable]) and control groups (17·7 months [not estimable]; unadjusted hazard ratio 1·12, 95% CI 0·83-1·51; p=0·47). In the subgroup analyses, honey increased the risks of both the primary endpoint (1·85, 1·05-3·24; p=0·03) and peritonitis (2·25, 1·16-4·36) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=0·1) and deaths (14 vs 18, respectively; p=0·9) were not significantly different in the honey and control groups. 11 (6%) participants in the honey group had local skin reactions.INTERPRETATION: The findings of this trial show that honey cannot be recommended routinely for the prevention of peritoneal-dialysis-related infections.FUNDING: Baxter Healthcare, Queensland Government, Comvita, and Gambro.
AB - BACKGROUND: There is a paucity of evidence to guide the best strategy for prevention of peritoneal-dialysis-related infections. Antibacterial honey has shown promise as a novel, cheap, effective, topical prophylactic agent without inducing microbial resistance. We therefore assessed whether daily application of honey at the exit site would increase the time to peritoneal-dialysis-related infections compared with standard exit-site care plus intranasal mupirocin prophylaxis for nasal carriers of Staphylococcus aureus.METHODS: In this open-label trial undertaken in 26 centres in Australia and New Zealand, participants undergoing peritoneal dialysis were randomly assigned in a 1:1 ratio with an adaptive allocation algorithm to daily topical exit-site application of antibacterial honey plus standard exit-site care or intranasal mupirocin prophylaxis (only in carriers of nasal S aureus) plus standard exit-site care (control group). The primary endpoint was time to first infection related to peritoneal dialysis (exit-site infection, tunnel infection, or peritonitis). The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12607000537459.FINDINGS: Of 371 participants, 186 were assigned to the honey group and 185 to the control group. The median peritoneal-dialysis-related infection-free survival times were not significantly different in the honey (16·0 months [IQR not estimable]) and control groups (17·7 months [not estimable]; unadjusted hazard ratio 1·12, 95% CI 0·83-1·51; p=0·47). In the subgroup analyses, honey increased the risks of both the primary endpoint (1·85, 1·05-3·24; p=0·03) and peritonitis (2·25, 1·16-4·36) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=0·1) and deaths (14 vs 18, respectively; p=0·9) were not significantly different in the honey and control groups. 11 (6%) participants in the honey group had local skin reactions.INTERPRETATION: The findings of this trial show that honey cannot be recommended routinely for the prevention of peritoneal-dialysis-related infections.FUNDING: Baxter Healthcare, Queensland Government, Comvita, and Gambro.
UR - http://www.scopus.com/inward/record.url?scp=84890430823&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(13)70258-5
DO - 10.1016/S1473-3099(13)70258-5
M3 - Article
C2 - 24119840
AN - SCOPUS:84890430823
SN - 1473-3099
VL - 14
SP - 23
EP - 30
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 1
ER -