NDT Advance Access originally published online on May 16, 2006
Nephrology Dialysis Transplantation 2006 21(9):2536-2542; doi:10.1093/ndt/gfl235
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Oral rifampin for prevention of S. aureus carriage-related infections in patients with renal failure—a meta-analysis of randomized controlled trials
1 Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece and 2 Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
Correspondence and offprint requests to: Matthew E. Falagas, MD, MSc, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece. Email: m.falagas{at}aibs.gr
Background. Rifampin has been studied as prophylaxis against Staphylococcus aureus-related infections in patients on dialysis.
Methods. We performed a meta-analysis of randomized controlled trials (RCTs) that compared the effectiveness and safety of oral rifampin with another regimen or no therapy in reducing S. aureus-related infections in dialysis patients.
Results. Four RCTs evaluated oral rifampin (administered for 5 days every 3 months, or for 5 days once) as prophylaxis in dialysis patients. Oral rifampin with or without bacitracin was associated with less access-site infections with S. aureus compared with no treatment (odds ratio = 0.16, 95% confidence intervals: 0.06–0.44, 3 RCTs). There was no difference between prophylaxis with oral rifampin and topical mupirocin applied at the catheter site, for all studied outcomes, in the RCT comparing these regimens. Withdrawal from the study due to drug-related toxicity occurred in 7/107 (6.6%) of the studied patients with renal failure. Development of resistance of S. aureus to rifampin ranged from 0 to 18.2% (reported in three out of four included RCTs).
Conclusion. Prophylactic use of oral rifampin reduces access-site infections with S. aureus in patients with renal failure undergoing dialysis. However, development of toxicity and antimicrobial resistance during the treatment with rifampin occur in considerable proportions of patients, limiting its use and supporting the guidelines that recommend the use of local antibiotics at the exit site, such as mupirocin, for these indications. The available data are rather limited and more studies should be performed to examine this important clinical question.
Keywords: bacitracin; catheter; mupirocin; peritonitis; rifampicin