A Retrospective Sequential Comparison of Topical Application of Medicated Honey and Povidone Iodine for Preventing Peritoneal Dialysis Catheter-Related Infections

Application of medicated honey (MH) to peritoneal dialysis (PD) catheter exit sites has been found to be as effective as intra-nasal mupirocin for preventing PD catheter-related infections (CRIs), but was associated with increased risk for CRIs in diabetics. The efficacy of topical MH as a prophylactic agent has not been compared with the exit-site application of povidone iodine (PI). This retrospective multicentre cohort study compared cumulative incidence rates of PD CRIs (peritonitis or exit-site infections) and the number of PD CRIs observed per patient over the study period with PD exit-site application of MH or PI, in both diabetic and non-diabetic patients. Outcomes were compared in incident patients in 2 eras: January 2011 – December 2012, when 147 received exit-site care with PI (PI group), and July 2013 – June 2015, when 171 patients applied MH (MH group). Patients were followed until technique failure, death, transplant, or end of study treatment era. Cumulative incidence of PD CRIs was higher in the PI group (hazard ratio [HR] = 1.7, 95% confidence interval [CI] 1.1 – 2.6, p = 0.019) and the benefit of MH was not modified by diabetic status (present/absent, interaction p = 0.723). A similar trend was observed in the cumulative incidence of peritonitis (HR = 1.6, 95% CI 0.99 – 2.6, p = 0.059). After adjusting for months of exposure, the rate ratio for PD CRIs was 1.58 for PI compared to MH (95% CI, 1.03 – 2.42, p = 0.035). We conclude that exit-site application of MH is more effective than PI in preventing PD CRIs, and this effect is not modified by the presence or absence of diabetes.