Bismuth coating of non-tunneled haemodialysis catheters reduces bacterial colonization: a randomized controlled trial

Abstract

Background. Haemodialysis (HD) catheter-related blood stream infections are a major cause of morbidity and mortality in patients with acute and chronic renal failure.Methods. We conducted a randomized, prospective, double-blinded trial investigating the clinical value of bismuth-coated non-tunneled HD catheters in patients in need of temporary short-term vascular access. A standard catheter (SC) was compared to a surface-modified, bismuth-film-coated catheter (FCC). After removal of the catheter for any reason, both arterial and venous lumina were rinsed and the fluid cultured for detection of bacterial colony-forming units (CFU). The catheter tip was placed in a tube containing sterile saline, sonicated and shortly centrifuged to remove debris (3 min at 1000 g). The supernatant was cultured and assayed for DNA content.Results. Seventy-seven patients in three HD units were randomized. Thirteen patients suffered from acute renal failure, 60 patients from chronic renal failure, and four patients without renal insufficiency were treated with plasma exchange. The time to catheter removal was not significantly different between groups, with a mean of 18.5 ± 2 days for SC and 15.1 ± 2 days for FCC. In most cases, the reasons for catheter removal were related to no further need for extracorporeal therapy or establishment of a permanent vascular access. Six catheters for SC and four catheters for FCC were removed because of presumed infection. Bacterial colonization was significantly lower for coated catheters compared to standard catheters, both for cultured catheter tips as well as for CFU in rinse fluids (P < 0.05).Conclusions. Surface modification with bismuth film reduces bacterial colonization of temporary non-tunneled HD catheters in a clinical trial. Larger trials with these modified catheters are justified to further investigate the effect on catheter-related infections, complications and costs.

Exometabolome Analysis Identifies Pyruvate Dehydrogenase as a Target for the Antibiotic Triphenylbismuthdichloride in Multiresistant Bacterial Pathogens

“…TPBC has interesting antimicrobial properties against bacterial PDHCs from unrelated organisms, such as firmicutes and proteobacteria, and it has been successfully used to coat catheters as a preventive strategy against device-related infections (28,29). Thorough toxicological studies will be necessary in the future to explore if TPBC or related compounds may become candidates for further antiinfective applications.…”

“…1) was shown in the 1960s (38) to have antimicrobial activity and has hardly been further investigated since then. Only recently has TPBC been used as an additive of catheter coatings to prevent device-associated infections, which yielded very promising results in clinical studies (28,29) and prompted us to analyze the antimicrobial properties of TPBC against clinically relevant bacterial pathogens. TPBC had antibacterial activity against Gram-positive pathogens, such as staphylococci and enterococci, including methicillin-resistant S. aureus and VRE strains ( Table 1).…”

“…In this study, we analyzed antibacterial activities of the synthetic compound triphenylbismuthdichloride (TPBC), which has proven efficacy in preventing catheter-associated infections (28,29). TPBC was found to have strong antimicrobial activity against major bacterial pathogens, among them many antibioticresistant strains, such as methicillin-resistant S. aureus and VRE.…”

A Comparison of the Niagara™ and Medcomp™ Catheters for Continuous Renal Replacement Therapy

“…In addition, microthrombus formation in the catheter remains a major problem that compromises dialysis adequacy, shortens access lifespan, and results in circuit failure. [4][5][6][7][8][9] Different catheters are available in the market for CRRT including bismuth-coated catheters [10][11][12] and catheters of different lumen design, diameter, and cross-sectional surface. These properties may influence circuit life and therefore have practical implications.…”

Prevention of Central Line–Associated Bloodstream Infections: A Journey Toward Eliminating Preventable Harm

“…Before insertion, for example, health care personnel need to be educated about CLABSI prevention and perform appropriate hand hygiene. At the time of insertion, personnel should avoid the femoral site in adult patients, use maximal sterile barrier precautions and chlorhexidine-based antiseptic for skin preparation, use a catheter cart or kit that contains all necessary components Since the publication of the most recent prevention guidelines in 2008 [5, 14••], additional studies have focused on anti-infective compounds such as chlorhexidine gluconate-impregnated sponges, chlorhexidine/silver sulfadiazine, 5-fluorouracil, bismuth, minocycline/rifampin, and trisodium citrate to reduce bacterial transmission along the catheter tract [15][16][17] and anti-infective lock solutions containing gentamicin or ethanol to reduce bacterial transmission through the catheter ports [18][19][20]. Future guidelines, including updated guidelines from the Healthcare Infection Control Practices Advisory Committee (HICPAC), will likely evaluate the strength of this recent evidence in the context of existing prevention strategies.…”