The effect of exit-site antibacterial honey versus nasal mupirocin prophylaxis on the microbiology and outcomes of peritoneal dialysis-associated peritonitis and exit-site infections: A sub-study of the Honeypot trial

Lei Zhang, Sunil V. Badve, Elaine M. Pascoe, Elaine Beller, Alan Cass, Carolyn Clark, Janak De Zoysa, Nicole M. Isbel, Steven McTaggart, Alicia T. Morrish, E. Geoffrey Playford, Anish Scaria, Paul Snelling, Liza A. Vergara, Carmel M. Hawley, David W. Johnson, HONEYPOT Study Collaborative Group

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Abstract

Background: The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and techniquefailure. Methods: A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care (N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis-and infection-associated hospitalization, and technique failure (PD withdrawal). Results: The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32-0.50) and 0.41 (95% CI 0.33-0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75-1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66-1.49), gram-negative (IRR 0.71, 95% CI 0.39-1.29), culture-negative (IRR 2.01, 95% CI 0.91-4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36-3.20). Exit-site infection rates were 0.37 (95% CI 0.28-0.45) and 0.33 (95% CI 0.26-0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81-1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70-1.72), gram-negative (IRR: 0.85, 95% CI 0.46-1.58), culture-negative (IRR 1.88, 95% CI 0.67-5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40-2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. Conclusion: Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.

Original languageEnglish
Pages (from-to)712-721
Number of pages10
JournalPeritoneal Dialysis International
Volume35
Issue number7
DOIs
Publication statusPublished - 1 Dec 2015

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Mupirocin
Honey
Peritoneal Dialysis
Microbiology
Peritonitis
Nose
Confidence Intervals
Infection
Incidence
Hospitalization
Control Groups

Cite this

Zhang, Lei ; Badve, Sunil V. ; Pascoe, Elaine M. ; Beller, Elaine ; Cass, Alan ; Clark, Carolyn ; De Zoysa, Janak ; Isbel, Nicole M. ; McTaggart, Steven ; Morrish, Alicia T. ; Geoffrey Playford, E. ; Scaria, Anish ; Snelling, Paul ; Vergara, Liza A. ; Hawley, Carmel M. ; Johnson, David W. ; HONEYPOT Study Collaborative Group. / The effect of exit-site antibacterial honey versus nasal mupirocin prophylaxis on the microbiology and outcomes of peritoneal dialysis-associated peritonitis and exit-site infections : A sub-study of the Honeypot trial. In: Peritoneal Dialysis International. 2015 ; Vol. 35, No. 7. pp. 712-721.
@article{2678d465d5514ec49402b4249f035c38,
title = "The effect of exit-site antibacterial honey versus nasal mupirocin prophylaxis on the microbiology and outcomes of peritoneal dialysis-associated peritonitis and exit-site infections: A sub-study of the Honeypot trial",
abstract = "Background: The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and techniquefailure. Methods: A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care (N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis-and infection-associated hospitalization, and technique failure (PD withdrawal). Results: The mean peritonitis rates in the honey and control groups were 0.41 (95{\%} confidence interval [CI] 0.32-0.50) and 0.41 (95{\%} CI 0.33-0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95{\%} CI 0.75-1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95{\%} CI 0.66-1.49), gram-negative (IRR 0.71, 95{\%} CI 0.39-1.29), culture-negative (IRR 2.01, 95{\%} CI 0.91-4.42), or polymicrobial peritonitis (IRR 1.08, 95{\%} CI 0.36-3.20). Exit-site infection rates were 0.37 (95{\%} CI 0.28-0.45) and 0.33 (95{\%} CI 0.26-0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95{\%} CI 0.81-1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95{\%} CI 0.70-1.72), gram-negative (IRR: 0.85, 95{\%} CI 0.46-1.58), culture-negative (IRR 1.88, 95{\%} CI 0.67-5.29), or polymicrobial ESI (IRR 1.00, 95{\%} CI 0.40-2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. Conclusion: Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.",
author = "Lei Zhang and Badve, {Sunil V.} and Pascoe, {Elaine M.} and Elaine Beller and Alan Cass and Carolyn Clark and {De Zoysa}, Janak and Isbel, {Nicole M.} and Steven McTaggart and Morrish, {Alicia T.} and {Geoffrey Playford}, E. and Anish Scaria and Paul Snelling and Vergara, {Liza A.} and Hawley, {Carmel M.} and Johnson, {David W.} and {HONEYPOT Study Collaborative Group}",
year = "2015",
month = "12",
day = "1",
doi = "10.3747/pdi.2014.00206",
language = "English",
volume = "35",
pages = "712--721",
journal = "Peritoneal Dialysis Bulletin",
issn = "0896-8608",
publisher = "MultiMed Inc.",
number = "7",

}

Zhang, L, Badve, SV, Pascoe, EM, Beller, E, Cass, A, Clark, C, De Zoysa, J, Isbel, NM, McTaggart, S, Morrish, AT, Geoffrey Playford, E, Scaria, A, Snelling, P, Vergara, LA, Hawley, CM, Johnson, DW & HONEYPOT Study Collaborative Group 2015, 'The effect of exit-site antibacterial honey versus nasal mupirocin prophylaxis on the microbiology and outcomes of peritoneal dialysis-associated peritonitis and exit-site infections: A sub-study of the Honeypot trial' Peritoneal Dialysis International, vol. 35, no. 7, pp. 712-721. https://doi.org/10.3747/pdi.2014.00206

The effect of exit-site antibacterial honey versus nasal mupirocin prophylaxis on the microbiology and outcomes of peritoneal dialysis-associated peritonitis and exit-site infections : A sub-study of the Honeypot trial. / Zhang, Lei; Badve, Sunil V.; Pascoe, Elaine M.; Beller, Elaine; Cass, Alan; Clark, Carolyn; De Zoysa, Janak; Isbel, Nicole M.; McTaggart, Steven; Morrish, Alicia T.; Geoffrey Playford, E.; Scaria, Anish; Snelling, Paul; Vergara, Liza A.; Hawley, Carmel M.; Johnson, David W.; HONEYPOT Study Collaborative Group.

In: Peritoneal Dialysis International, Vol. 35, No. 7, 01.12.2015, p. 712-721.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The effect of exit-site antibacterial honey versus nasal mupirocin prophylaxis on the microbiology and outcomes of peritoneal dialysis-associated peritonitis and exit-site infections

T2 - A sub-study of the Honeypot trial

AU - Zhang, Lei

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 - Geoffrey Playford, E.

AU - Scaria, Anish

AU - Snelling, Paul

AU - Vergara, Liza A.

AU - Hawley, Carmel M.

AU - Johnson, David W.

AU - HONEYPOT Study Collaborative Group

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background: The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and techniquefailure. Methods: A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care (N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis-and infection-associated hospitalization, and technique failure (PD withdrawal). Results: The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32-0.50) and 0.41 (95% CI 0.33-0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75-1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66-1.49), gram-negative (IRR 0.71, 95% CI 0.39-1.29), culture-negative (IRR 2.01, 95% CI 0.91-4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36-3.20). Exit-site infection rates were 0.37 (95% CI 0.28-0.45) and 0.33 (95% CI 0.26-0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81-1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70-1.72), gram-negative (IRR: 0.85, 95% CI 0.46-1.58), culture-negative (IRR 1.88, 95% CI 0.67-5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40-2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. Conclusion: Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.

AB - Background: The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and techniquefailure. Methods: A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care (N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis-and infection-associated hospitalization, and technique failure (PD withdrawal). Results: The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32-0.50) and 0.41 (95% CI 0.33-0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75-1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66-1.49), gram-negative (IRR 0.71, 95% CI 0.39-1.29), culture-negative (IRR 2.01, 95% CI 0.91-4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36-3.20). Exit-site infection rates were 0.37 (95% CI 0.28-0.45) and 0.33 (95% CI 0.26-0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81-1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70-1.72), gram-negative (IRR: 0.85, 95% CI 0.46-1.58), culture-negative (IRR 1.88, 95% CI 0.67-5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40-2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. Conclusion: Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.

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U2 - 10.3747/pdi.2014.00206

DO - 10.3747/pdi.2014.00206

M3 - Article

VL - 35

SP - 712

EP - 721

JO - Peritoneal Dialysis Bulletin

JF - Peritoneal Dialysis Bulletin

SN - 0896-8608

IS - 7

ER -