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 technique failure. ♦
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.