The 47th ESPN Congress in Porto, Portugal, September 18-20, 2014

Abstract

Introduction: International guidelines in peritoneal dialysis (PD) advocate for regular application of topical mupirocin in chronic PD exit-site care. A strong evidence base links this treatment to reduced rates of exitsite infections and peritonitis (ESIP), however emerging reports of increasing mupirocin resistance and gram negative exit-site floral replacement and ESIP are threatening the long term viability of topical antibiotic ointments as a prophylactic treatment. Honey has multiple, proven, antibacterial and wound healing properties. A recent Cochrane Review of topical honey for wound healing found some benefit for superficial and partial thickness burns but not for chronic venous ulcers. Recent randomised controlled trials have not proven honey to be superior to mupirocin in ESIP prophylaxis. No exclusively paediatric studies have been performed but numerous case series advocate for a beneficial effect in promoting healing of complex and infected paediatric wounds. Material and methods: We present a photographic case series of 8 paediatric patients with PD exit site infections and/or over-granulation successfully treated with topical medical grade honey in place of topical antibiotic mupirocin, accompanied by a literature review of medical honey for the treatment of paediatric wounds. Results: Improvement was observed in all cases which we objectified by assessment usingmodified Twardowski criteria, from a median score of 3 ('acute infection') to a median score of 1 ('good'). Conclusions: Medical grade honey is the first line prophylactic exit-side ointment in peritoneal dialysis exit-sites at our institution.We are increasingly turning to honey to salvage infected exit sites threatening the need for removal, with much success. Increasing case reports and series are suggesting improvement in infected and poorly healing wounds in children with complex medical conditions.