Mangosteen-Derived Mangostin as a Topical Prophylaxis Against Catheter-Related Infections: A Multicenter, Double-Blind Randomized Placebo-Controlled Trial

Abstract

Background: Non-tunneled hemodialysis (HD) catheters (NTHCs) are associated with high rates of systemic and localized infections. Mangostin, a xanthone derived from mangosteen, exhibits antimicrobial and anti-inflammatory properties; however, its clinical efficacy in preventing exit site infection (ESI) and catheter-related bloodstream infection (CRBSI) has not been established. The present study evaluated the efficacy of topical mangostin ointment in preventing systemic and local infection.
Methods: This multicenter, double-blind, randomized, placebo-controlled trial enrolled 66 acute and chronic HD patients from 3 hospitals. Participants were randomized to receive topical mangosteen-derived mangostin ointment (mangostin group) or a placebo, applied at the catheter exit site immediately following insertion, and were monitored until catheter removal.
Results: The composite incidence of ESI and CRBSI was significantly lower in the mangostin group than in the placebo group (P=0.025), corresponding to a 78% risk reduction. Furthermore, a higher proportion of patients in the mangostin group had mild inflammation (exit-site inflammation score ≤2) (p=0.008).
Conclusion: Topical mangostin significantly reduces the combined incidence of local and systemic infection and inflammation in patients with NTHC. Further studies are needed to explore its efficacy in patients with a tunneled HD catheter or a peritoneal dialysis catheter.