Inthe PD literature, peritonitis has been referred to as an Achilles’ heelbecause it could lead to catheter removal and PD treatment failure. Topicalantibiotics have been used for prevention of an exit site infection (ESI) whichmay precede and lead to peritonitis.Forthis purpose, most centers use mupirocin as their first choice. It has reducedthe ESI significantly, but mupirocin-resistant S. aureus and P. aeruginosaESI have emerged. Then came gentamicin which is superior to mupirocin. However, gentamicin-resistant P.aeruginosa has already been reported… How can we break thiscycle?
FOODwas the bright idea! Not any food but a very specific sweet treat – honey. Honeyhas been applied to wounds since ancient times, but only recently have we cometo understand its antibacterial properties: acidity (pH 3-4), high osmolarity(3000 mOsm/kg), H2O2, methyl glyoxal, bee defensin-1,etc. In vitro, honey killed bacteria including MRSA, β-lactamase producing E. Coli, ciprofloxacin-resistant P. aeruginosa and VRE! Because of its multiple antibacterial mechanisms, there is a lowlikelihood that bacteria will gain resistance.
But does it work invivo? It has been shown that honey heals wounds and maintains sterility.Then, an Australian and New Zealand group tested standardized antibacterialhoney (Medihoney) for HD catheter-associated infections andits effectiveness was comparable to mupirocin.
Now the same group isconducting the HONEYPOT study to see its efficacy in reducing the risk of PDinfection. This is one of the initiatives to improve the PD technique survival in the region which islower than in other parts of the world.
The results of theHONEYPOT study are pending, but it would be exciting if honey is proven to bean effective alternative prophylaxis with less chance of bacterial resistance.Penicillin was discovered from fungi. Gentamicin is synthesized by bacteria.Maybe it’s time to ask for honey bees for help.
Posted by Tomoki Tsukahara
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