A Taurolidine–Citrate–Heparin Lock Solution Effectively Eradicates Pathogens From the Catheter Biofilm in Hemodialysis Patients

Abstract

Catheter-related bacteremia (CRB) is a typical complication of hemodialysis catheter use. Catheter lumen colonization by pathogens is regarded as a direct cause of CRB. Once settled, the catheter biofilm increases the risk of developing infection, thus necessitating insertion replacement and antibiotic treatment. The study assessed the self-sufficient efficacy of taurolidine-citrate-heparin lock solution in eradicating catheter biofilm bacteria and keeping it sterile in patients on hemodialysis. Twenty-nine chronic patients on hemodialysis with tunneled and nontunneled catheters locked with a heparin filling (the mean time of heparin lock use -30.1 ± 2.0 days) and subsequently converted to a taurolidine-citrate-heparin filling were included. Peripheral vein and catheter lumen blood cultures were obtained before the filling change and after taurolidine-citrate-heparin lock use (mean time 33.8 ± 7.6 days). Twenty-four participants with tunneled and nontunneled catheters locked with taurolidine-citrate-heparin filling served as the control group. During the heparin-locking period, CRB was diagnosed in 3 cases (only nontunneled catheters). The catheter blood cultures findings were positive in 23 patients (10 temporary and 13 permanent catheters), whereas both the catheter and peripheral vein blood cultures were sterile in 3 of 29 subjects (only permanent catheters). Irrespective of catheter type (tunneled or nontunneled), repeated culture revealed no pathogens in any of the 23 patients with initial positive catheter blood culture, after the use of taurolidine-citrate-heparin filling. No positive blood culture was noted in the control group. The taurolidine-citrate-heparin lock solution effectively eradicated pathogens from nontunneled and tunneled catheter biofilms and helped to maintain catheter lumen sterility.

In vitro activity of taurolidine gel on bacteria associated with periodontitis

“…Taurolidine solutions have been successfully proven as a catheter-lock agent to prevent catheter-related bloodstream infections in patients on home parenteral nutrition [18,19], in central venous catheters in children with cancer [20], and in hemodialysis patients [21]. By designing our study, we aimed to gain more insight on the potential use of taurolidine as alternative to commonly used topical antimicrobials, e.g., minocycline.…”

Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial

“…The reduction in CR-BSI rates using lock solution has been evidenced in various trials and meta-analyses published recently, yet the best prophylactic lock therapy option is still the subject of study (Silva et al, 2012;Filiopoulos et al, 2011;Weijmer et al, 2005;Zwiech et al, 2016;Solomon et al, 2010;Murray et al, 2014;Takla et al, 2007;Vercaigne et al, 2016;Maki et al, 2011;Dogra et al, 2002;Kim et al, 2006;Nori et al, 2006; Al-Hwiesh and -Rahman, 2007;Campos et al, 2011;Moran et al, 2012;Moore et al, 2014;Hemmelgarn et al, 2011;Wasse, 2008). In this study, the use of prophylactic lock therapy was studied only in catheters tunneled for HD, with a follow-up of at least 6 months, comparing solutions containing antibiotics (gentamicin + cefazolin) versus antimicrobial solutions (taurolidine + citrate); these solutions presented similar results in reducing CR-BSI and ESI.…”

What is the evidence for intraluminal colonization of hemodialysis catheters?

“…However, 17 of these 28 patients had a relapse of catheter colonization with a median free interval of 70 days (range 2-101 days). In one of the above-noted studies, 21 23 patients who only had growth from catheter-drawn blood cultures of coagulase-negative staphylococci or Staphylococcus aureus then had their hemodialysis catheters locked once with a combination of taurolidine, citrate, and urokinase and then locked after each dialysis session with a combination of taurolidine, citrate, and heparin. When these patients had repeat catheter-drawn blood cultures after removal of the locking solution 34±8 days later, none of these cultures had microbial growth.…”

“…Other investigators found that all 26 patients using either temporary or permanent hemodialysis catheters dialyzed for 51 ± 35 days had blood cultures growing predominantly coagulase-negative staphylococci drawn through catheter lumens after discarding heparinlocking solutions. 21 Three of the 26 had concomitant percutaneously drawn blood cultures.…”

“…13,14,18,20,21 Finally, in one study, 16 the case definition for CRBSI was met if a catheter-drawn blood culture or a percutaneously drawn blood culture was documented rather than requiring growth in the latter culture to meet the case definition. Nevertheless, data derived from the above-noted studies suggest that intraluminal hemodialysis catheter colonization often precedes CRBSI measured by concomitant growth from percutaneously drawn blood cultures.…”