Mupirocin proves safety as prevention for catheter-related infections in pilot study

Use of topical mupirocin prophylaxis is feasible and has an acceptable safety profile for the long-term prevention of indwelling pleural catheter (IPC)- or indwelling peritoneal catheter (IPeC)-related infections, results of a pilot study have shown.

“Our findings provide the platform for future randomized trials with sufficient power to determine the efficacy of mupirocin as a prophylactic agent, as well as to provide additional insights into the microorganism coverage of mupirocin in patients with an IPC,” the investigators said.

“If mupirocin is proven to be effective, it could have a significant impact on the quality of life of patients with life-limiting illnesses, as well as for those with benign pleural effusions,” they added.

In this study, the investigating team applied three preparations of mupirocin onto segments of IPC thrice weekly and examined these using scanning electron microscope (SEM) at different time intervals.

Topical mupirocin prophylaxis was administered to consecutive patients fitted with IPC or IPeC to apply to the catheter exit-site following every drainage/dressing change (at least twice weekly). The investigators followed them up for 6 months.

The median follow-up was 121 days. Mupirocin applied for up to 6 months did not lead to any detectable structural catheter damage. [Respirology 2024;29:176-182]

Overall, 50 indwelling catheters were inserted in 48 patients for malignant pleural (n=41) and peritoneal (n=9) effusions. All of them tolerated mupirocin well, but one patient had short-term local tenderness. Compliance was also excellent; of the 989 scheduled doses, 95.8 percent were delivered.

Of the patients, six developed catheter-related pleural (n=3), concurrent peritoneal/local (n=1), and skin/tract (n=2) infections. Common pathogens that caused these infections were as follows: Streptococcus mitis (with Bacillus species or anaerobes), Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa.

Preventive strategy

“IPC is commonly used in patients with advanced cancer who have significant comorbidities and are at an increased risk of infection,” the investigators said.

Most studies so far have focused on the management of catheter-related infections instead of prevention. The current study is a primary effort to explore a long-term infection prevention strategy using mupirocin. [BMJ Open Respir Res 2016;3:e000123; J Thorac Dis 2018;10:4659-4666]

“Mupirocin is a topical antibiotic with high level of activity against most Gram-positive organisms such as staphylococci and streptococci, as well as certain Gram-negative organisms,” the investigators said.

“This antimicrobial profile makes mupirocin an attractive option for the setting of indwelling catheter prophylaxis, as Gram-positive organisms, especially S. aureus are the predominant causative microbes of IPC-related pleural infections,” they added. [Chest 2013;144:1597-1602]

Currently, studies on IPC-related cellulitis and tract infections are limited, but existing research has shown the efficacy of mupirocin prophylaxis in reducing such infections in the context of peritoneal dialysis. [Perit Dial Int 2005;25:473-477; Perit Dial Int 2003;23(Suppl 2):S153-S158]

“Resistance to mupirocin is unlikely to be a significant concern given the short median duration of survival of patients with malignant pleural effusion,” the investigators said. “A study in the context of PD has also reported low mupirocin resistance even after continuous application for up to 7 years.” [Thorax 2010;65(Suppl 2):ii32–ii40; Nephrol Dial Transplant 2004;19(12):3140-3143]