Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT)

a randomised trial

David Johnson, Sunil Badve, Elaine Pascoe, Elaine Beller, Alan Cass, Carolyn Clark, Janak de Zoysa, Nicole Isbel, Steven McTaggart, Alicia Morrish, Geoffrey Playford, Anish Scaria, Paul Snelling, Liza Vergara, Carmel Hawley, The HONEYPOT Study Collaborative Group

    Research output: Contribution to journalArticleResearchpeer-review

    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 (16·0 months [IQR not estimable]) and control groups (17·7 months [not estimable]; unadjusted hazard ratio 1·12, 95% CI 0·83–1·51; p=0·47). In the subgroup analyses, honey increased the risks of both the primary endpoint (1·85, 1·05–3·24; p=0·03) and peritonitis (2·25, 1·16–4·36) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=0·1) and deaths (14 vs 18, respectively; p=0·9) 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.
    Original languageEnglish
    Pages (from-to)23-30
    Number of pages8
    JournalLancet Infectious Diseases
    Volume14
    Issue number1
    DOIs
    Publication statusPublished - Jan 2014

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    Honey
    Peritoneal Dialysis
    Infection
    Mupirocin
    Control Groups
    Peritonitis
    New Zealand
    Nose
    Registries
    Staphylococcus aureus
    Clinical Trials
    Skin
    Incidence

    Cite this

    Johnson, D., Badve, S., Pascoe, E., Beller, E., Cass, A., Clark, C., ... The HONEYPOT Study Collaborative Group (2014). Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): a randomised trial. Lancet Infectious Diseases, 14(1), 23-30. https://doi.org/10.1016/S1473-3099(13)70258-5
    Johnson, David ; Badve, Sunil ; Pascoe, Elaine ; Beller, Elaine ; Cass, Alan ; Clark, Carolyn ; de Zoysa, Janak ; Isbel, Nicole ; McTaggart, Steven ; Morrish, Alicia ; Playford, Geoffrey ; Scaria, Anish ; Snelling, Paul ; Vergara, Liza ; Hawley, Carmel ; The HONEYPOT Study Collaborative Group. / Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT) : a randomised trial. In: Lancet Infectious Diseases. 2014 ; Vol. 14, No. 1. pp. 23-30.
    @article{051b83aa40764219acce202c6a576018,
    title = "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 (16·0 months [IQR not estimable]) and control groups (17·7 months [not estimable]; unadjusted hazard ratio 1·12, 95{\%} CI 0·83–1·51; p=0·47). In the subgroup analyses, honey increased the risks of both the primary endpoint (1·85, 1·05–3·24; p=0·03) and peritonitis (2·25, 1·16–4·36) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=0·1) and deaths (14 vs 18, respectively; p=0·9) 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.",
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    author = "David Johnson and Sunil Badve and Elaine Pascoe and Elaine Beller and Alan Cass and Carolyn Clark and {de Zoysa}, Janak and Nicole Isbel and Steven McTaggart and Alicia Morrish and Geoffrey Playford and Anish Scaria and Paul Snelling and Liza Vergara and Carmel Hawley and {The HONEYPOT Study Collaborative Group}",
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    Johnson, D, Badve, S, Pascoe, E, Beller, E, Cass, A, Clark, C, de Zoysa, J, Isbel, N, McTaggart, S, Morrish, A, Playford, G, Scaria, A, Snelling, P, Vergara, L, Hawley, C & The HONEYPOT Study Collaborative Group 2014, 'Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): a randomised trial', Lancet Infectious Diseases, vol. 14, no. 1, pp. 23-30. https://doi.org/10.1016/S1473-3099(13)70258-5

    Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT) : a randomised trial. / Johnson, David; Badve, Sunil; Pascoe, Elaine; Beller, Elaine; Cass, Alan; Clark, Carolyn; de Zoysa, Janak; Isbel, Nicole; McTaggart, Steven; Morrish, Alicia; Playford, Geoffrey; Scaria, Anish; Snelling, Paul; Vergara, Liza; Hawley, Carmel; The HONEYPOT Study Collaborative Group.

    In: Lancet Infectious Diseases, Vol. 14, No. 1, 01.2014, p. 23-30.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT)

    T2 - a randomised trial

    AU - Johnson, David

    AU - Badve, Sunil

    AU - Pascoe, Elaine

    AU - Beller, Elaine

    AU - Cass, Alan

    AU - Clark, Carolyn

    AU - de Zoysa, Janak

    AU - Isbel, Nicole

    AU - McTaggart, Steven

    AU - Morrish, Alicia

    AU - Playford, Geoffrey

    AU - Scaria, Anish

    AU - Snelling, Paul

    AU - Vergara, Liza

    AU - Hawley, Carmel

    AU - The HONEYPOT Study Collaborative Group, null

    PY - 2014/1

    Y1 - 2014/1

    N2 - 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 (16·0 months [IQR not estimable]) and control groups (17·7 months [not estimable]; unadjusted hazard ratio 1·12, 95% CI 0·83–1·51; p=0·47). In the subgroup analyses, honey increased the risks of both the primary endpoint (1·85, 1·05–3·24; p=0·03) and peritonitis (2·25, 1·16–4·36) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=0·1) and deaths (14 vs 18, respectively; p=0·9) 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.

    AB - 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 (16·0 months [IQR not estimable]) and control groups (17·7 months [not estimable]; unadjusted hazard ratio 1·12, 95% CI 0·83–1·51; p=0·47). In the subgroup analyses, honey increased the risks of both the primary endpoint (1·85, 1·05–3·24; p=0·03) and peritonitis (2·25, 1·16–4·36) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=0·1) and deaths (14 vs 18, respectively; p=0·9) 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.

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    KW - pseudomonic acid

    KW - unclassified drug

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    KW - hypoglycemia

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    KW - peritoneal dialysis

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    KW - randomized controlled trial

    KW - Staphylococcus aureus

    KW - Staphylococcus infection

    KW - survival time

    KW - uterus bleeding

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    DO - 10.1016/S1473-3099(13)70258-5

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    JO - The Lancet Infectious Diseases

    JF - The Lancet Infectious Diseases

    SN - 1473-3099

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