Mupirocin Application for Hemodialysis Catheter (Permacath) Infection Prevention
Apply mupirocin 2% ointment to the hemodialysis catheter exit site after catheter placement and at the end of each dialysis session (typically three times weekly). 1, 2
Application Regimen
Apply a small amount of mupirocin ointment directly to the catheter exit site after each dialysis session (typically 3 times per week for patients on standard hemodialysis schedules). 1, 2
The ointment should be applied following skin disinfection with povidone-iodine at the catheter insertion site. 1
Cover the treated area with a dry gauze dressing rather than transparent film dressings, as gauze poses less risk of exit site colonization. 3
Evidence Supporting This Approach
Mupirocin application at the catheter exit site dramatically reduces catheter-related bacteremia by approximately 83-90% compared to standard care alone. 1, 2, 4
In hemodialysis patients with central venous catheters, mupirocin reduced Staphylococcus aureus bacteremia from 8.92 to 0.71 episodes per 1000 patient-days (hazard ratio 7.2 for developing bacteremia without mupirocin). 1
For tunneled, cuffed catheters specifically, mupirocin reduced catheter-related bacteremia from 35% to 7% and significantly prolonged catheter survival (108 vs 31 days median). 2
The protective effect is primarily against staphylococcal infections, which are the leading cause of catheter-related infections in hemodialysis patients. 1, 2
Critical Caveats and Limitations
Check catheter material compatibility before using mupirocin, as it can degrade polyurethane catheters. 3
The polyethylene glycol base in mupirocin ointment may compromise the integrity of polyurethane catheters through plasticization. 3
Verify with the catheter manufacturer that mupirocin is compatible with your specific catheter material. 3
Silicone catheters may also be damaged if excessive amounts are applied directly to the catheter surface rather than the exit site. 5
Mupirocin resistance develops with routine use, though infection prevention benefits may still outweigh this concern. 3
Resistance to mupirocin can develop in both S. aureus and coagulase-negative staphylococci soon after routine use begins. 3
However, one study showed that after 7 years of routine prophylactic use, mupirocin resistance was found in only 2.7% of peritoneal dialysis patients overall. 6
Monitor local resistance patterns at your institution when deciding whether to implement this strategy. 3
Alternative Antiseptic Options
If mupirocin is contraindicated or resistance is a concern, povidone-iodine 10% ointment or polysporin ointment are effective alternatives. 3, 4
Povidone-iodine ointment reduced catheter-related bacteremia (RR 0.10) and is particularly effective in patients with nasal S. aureus colonization. 3, 4
Polysporin (bacitracin/gramicidin/polymyxin B) ointment reduced catheter-related bacteremia (RR 0.40) and showed mortality benefit in one study. 3, 4
These alternatives do not carry the same risk of antimicrobial resistance as mupirocin. 3
Verify that the chosen ointment does not interact with your catheter material per manufacturer recommendations. 3
Common Pitfalls to Avoid
Do not apply excessive amounts of ointment directly onto the catheter surface itself—this can cause physical damage including frosting, ballooning, and fracture even with gentamicin cream. 5
Do not use antibiotic ointments with no fungicidal activity if fungal colonization is a concern, as rates of Candida colonization may increase. 3
Do not rely on mupirocin alone—it should be part of a comprehensive infection prevention strategy including proper hand hygiene, maximal sterile barrier precautions, and chlorhexidine skin antisepsis. 3
Do not use topical honey as an alternative—it has not been shown to reduce exit site infections or catheter-related bacteremia in hemodialysis patients. 4