Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis:: A meta-analysis

A systematic review of the English- language literature was performed to determine the overall benefit of mupirocin therapy in reducing the rate of Staphylococcus aureus infection among patients undergoing hemodialysis ( HD) or peritoneal dialysis ( PD). Included studies met the following criteria: they were randomized clinical trials or cohort studies; cohorts consisted of adults ( age, greater than or equal to 18 years) requiring HD or PD; mupirocin therapy was administered to the treatment group, and placebo or no therapy was administered to the control group; and the primary outcome of interest was the difference in the number of S. aureus infections among mupirocin- treated and - untreated patients. Ten studies described in 9 articles were analyzed. A total of 2445 patients were included in the analysis. Use of mupirocin reduced the rate of S. aureus infections by 68% ( 95% confidence interval [ CI], 57% - 76%) among all patients undergoing dialysis; risk reductions were 80% ( 95% CI, 65% - 89%) among patients undergoing HD and 63% ( 95% CI, 50% - 73%) among patients undergoing PD. When data were stratified by type of infection, S. aureus bacteremia was found to be reduced by 78% among patients undergoing HD, and peritonitis and exit- site infections were found to be reduced by 66% and 62%, respectively, among patients undergoing PD. Mupirocin prophylaxis substantially reduces the rate of S. aureus infection in the dialysis population. Optimal regimens that minimize the emergence of mupirocin resistance need to be explored.