Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): A randomised trial

Abstract

Background: There is a paucity of evidence to guide the best strategy for prevention of peritoneal-dialysis-related infections. Antibacterial honey has shown promise as a novel, cheap, effective, topical prophylactic agent without inducing microbial resistance. We therefore assessed whether daily application of honey at the exit site would increase the time to peritoneal-dialysis-related infections compared with standard exit-site care plus intranasal mupirocin prophylaxis for nasal carriers of Staphylococcus aureus. Methods: In this open-label trial undertaken in 26 centres in Australia and New Zealand, participants undergoing peritoneal dialysis were randomly assigned in a 1:1 ratio with an adaptive allocation algorithm to daily topical exit-site application of antibacterial honey plus standard exit-site care or intranasal mupirocin prophylaxis (only in carriers of nasal S aureus) plus standard exit-site care (control group). The primary endpoint was time to first infection related to peritoneal dialysis (exit-site infection, tunnel infection, or peritonitis). The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12607000537459. Findings: Of 371 participants, 186 were assigned to the honey group and 185 to the control group. The median peritoneal-dialysis-related infection-free survival times were not significantly different in the honey (160 months [IQR not estimable]) and control groups (177 months [not estimable]; unadjusted hazard ratio 112, 95% CI 083-151; p=047). In the subgroup analyses, honey increased the risks of both the primary endpoint (185, 105-324; p=003) and peritonitis (225, 116-436) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=01) and deaths (14 vs 18, respectively; p=09) were not significantly different in the honey and control groups. 11 (6%) participants in the honey group had local skin reactions. Interpretation: The findings of this trial show that honey cannot be recommended routinely for the prevention of peritoneal-dialysis-related infections. Funding: Baxter Healthcare, Queensland Government, Comvita, and Gambro. 2014 Elsevier Ltd.<br />