2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) All Versions of this Article: ASN.2004110997v1 16/5/1456    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Johnson, D. W. Articles by Gibbs, H. Search for Related Content PubMed PubMed Citation Articles by Johnson, D. W. Articles by Gibbs, H.

Randomized, Controlled Trial of Topical Exit-Site Application of Honey (Medihoney) versus Mupirocin for the Prevention of Catheter-Associated Infections in Hemodialysis Patients

Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia

Address correspondence to: Prof. David Johnson, Department of Renal Medicine, Level 2, Ambulatory Renal and Transplant Services Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Queensland 4102, Australia. Phone: +61-7-3240-5080; Fax: +61-7-3240-5480; david_johnson{at}health.qld.gov.au

Received for publication November 24, 2004. Accepted for publication February 11, 2005.

The clinical usefulness of hemodialysis catheters is limited by increased infectious morbidity and mortality. Topical antiseptic agents, such as mupirocin, are effective at reducing this risk but have been reported to select for antibiotic-resistant strains. The aim of the present study was to determine the efficacy and the safety of exit-site application of a standardized antibacterial honey versus mupirocin in preventing catheter-associated infections. A randomized, controlled trial was performed comparing the effect of thrice-weekly exit-site application of Medihoney versus mupirocin on infection rates in patients who were receiving hemodialysis via tunneled, cuffed central venous catheters. A total of 101 patients were enrolled. The incidences of catheter-associated bacteremias in honey-treated (n = 51) and mupirocin-treated (n = 50) patients were comparable (0.97 versus 0.85 episodes per 1000 catheter-days, respectively; NS). On Cox proportional hazards model analysis, the use of honey was not significantly associated with bacteremia-free survival (unadjusted hazard ratio, 0.94; 95% confidence interval, 0.27 to 3.24; P = 0.92). No exit-site infections occurred. During the study period, 2% of staphylococcal isolates within the hospital were mupirocin resistant. Thrice-weekly application of standardized antibacterial honey to hemodialysis catheter exit sites was safe, cheap, and effective and resulted in a comparable rate of catheter-associated infection to that obtained with mupirocin (although the study was not adequately powered to assess therapeutic equivalence). The effectiveness of honey against antibiotic-resistant microorganisms and its low likelihood of selecting for further resistant strains suggest that this agent may represent a satisfactory alternative means of chemoprophylaxis in patients with central venous catheters.

This article has been cited by other articles:

				M. T. James, J. Conley, M. Tonelli, B. J. Manns, J. MacRae, B. R. Hemmelgarn, and for the Alberta Kidney Disease Network Meta-analysis: Antibiotics for Prophylaxis against Hemodialysis Catheter-Related Infections Ann Intern Med, April 15, 2008; 148(8): 596 - 605. [Abstract] [Full Text] [PDF]

				A. Simon, K. Traynor, K. Santos, G. Blaser, U. Bode, and P. Molan Medical Honey for Wound Care Still the 'Latest Resort'? Evid. Based Complement. Altern. Med., January 7, 2008; (2008) nem175v1. [Abstract] [Full Text] [PDF]

				M. Allon Current Management of Vascular Access Clin. J. Am. Soc. Nephrol., July 1, 2007; 2(4): 786 - 800. [Abstract] [Full Text] [PDF]

				P. C. Molan The evidence supporting the use of honey as a wound dressing. International Journal of Lower Extremity Wounds, March 1, 2006; 5(1): 40 - 54. [Abstract] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673