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Randomized, Controlled Trial of Topical Exit-Site Application of Honey (Medihoney) versus Mupirocin for the Prevention of Catheter-Associated Infections in Hemodialysis Patients
Abstract
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.
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“For example, prevention of exit site infection by coating catheters with honey was found to be at least as effective as povidone iodine [254] or mupirocin [255].”
From Candida glabrata Biofilms: How Far Have We Come? (2017) · cites this paper as [255]
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Metadata
- Authors
- Johnson, D. W., van Eps, C., Mudge, D. W., Wiggins, K. J., Armstrong, K., Hawley, C. M., Campbell, S. B., Isbel, N. M., Nimmo, G. R., & Gibbs, H.
- Affiliations
- The University of Queensland (AU)
- Corresponding author
- Johnson, David Wayne
- ORCID
- Venue
- Journal of the American Society of Nephrology
- Published
- 2005-05
- Volume
- 16
- Issue
- 5
- Pages
- 1456-1462
- ISSN
- 1046-6673 (ISSN-L)
- OpenAlex
- W2139683791
- Cited by
- 162
- References
- 41
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 6 · 2023: 5 · 2022: 4 · 2021: 3 · 2020: 8 · 2019: 6 · 2018: 4 · 2017: 2 · 2016: 9 · 2015: 10 · 2014: 7 · 2013: 13 · 2012: 10
- FWCI
- 15.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Society of Nephrology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Smith and Nephew
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Central Venous Catheters and Hemodialysis
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Urology › Urinary Tract Infections Management
- Keywords
- honey, mupirocin, catheter exit site infection, catheter-related bacteremia, hemodialysis catheter, central venous catheters, antibiotic resistance, topical antibiotics, infection control, staphylococcal isolates
- MeSH terms
- Adult, Aged, Anti-Bacterial Agents, Bandages, Catheterization, Central Venous, Female, Renal Dialysis, Honey, Humans, Kidney Failure, Chronic, Male, Middle Aged, Risk Factors, Bacteremia, Drug Costs, Mupirocin, Disease-Free Survival
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