Central venous catheters and catheter locks in children with cancer: A prospective randomized trial of taurolidine versus heparin

Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik Daa

doi:10.1002/pbc.24482

Cited by 54 publications

(51 citation statements)

References 33 publications

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“…In the ATAPAC trial, the TIVAP-RI inci- 104 dence rate of both groups is consistent with the literature data reporting a rate from 0.11 to 1.45‰ catheter-days [4,[13][14][15][16][17] . Despite a relative risk reduction of 4 times by TauroLock, this difference was not statistically significant because the TIVAP-RI incidence rate observed in the control group was significantly lower than the one chosen as reference of 3‰ catheter-days for sample size calculation.…”

Section: Discussionsupporting

confidence: 79%

“…Several studies have confirmed an important activity of TauroLock in TIVAP-RI prevention in high-risk patients [10][11][12][13] . In the ATAPAC trial, the TIVAP-RI inci- 104 dence rate of both groups is consistent with the literature data reporting a rate from 0.11 to 1.45‰ catheter-days [4,[13][14][15][16][17] .…”

Section: Discussionmentioning

confidence: 99%

“…TauroLock TM , a catheter taurolidine lock solution containing 1.35% taurolidine and 4% citrate, can avoid bacterial adhesion to the inner TIVAP surface and, consequently, biofilm formation [9] . Some clinical trials have demonstrated the efficacy of TauroLock in reducing the TIVAP-RI incidence in patients on home total parenteral nutrition (TPN), in hemodialysis patients, and in pediatric cancer patients [10][11][12][13] . Recent data seem to support the use of TauroLock in the TI-VAP-RI prevention, even in cancer patients, particularly in those at higher risk of TIVAP-RIs [14] .…”

Section: Introductionmentioning

confidence: 99%

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Taurolidine/Citrate Lock Therapy for Primary Prevention of Catheter-Related Infections in Cancer Patients: Results of a Prospective, Randomized, Phase IV<b> </b>Trial (ATAPAC)

Longo¹,

Llorens

Goetz

et al. 2017

Oncology

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Background: Totally implantable venous access port (TIVAP)-related infections (RIs) remain a serious health problem in cancer patients receiving an intravenous (i.v.) therapy. Patients and Methods: The ATAPAC study was a prospective, randomized, monocentric, phase IV trial evaluating the efficacy of taurolidine lock solution versus standard saline solution for primary TIVAP-RI prevention in nonhematological cancer patients receiving i.v. chemotherapy. The primary endpoint was the TIVAP-RI incidence rate. From December 2014 to September 2015, 163 patients were enrolled in the study (taurolidine: n = 86 vs. control: n = 77). Four patients in the control group (5%) had a Staphylococcus epidermidis TIVAP-RI, and 1 patient (1%) in the taurolidine group had a Staphylococcus aureus infection. The TIVAP-RI incidence rate was 0.4 and 0.1‰ catheter-days, respectively (p = 0.21). The infection-free TIVAP survival was not statistically significant (p = 0.09). TIVAP-RI required a total of 22 hospitalization days in the taurolidine group versus 106 days in the control arm with associated costs of EUR 4,849 and EUR 36,020, respectively. Taurolidine-related toxicity was transitory and classified as grade I. Conclusions: The ATAPAC trial did not show a significant risk-infection reduction by TauroLock™. A larger, prospective, randomized trial is needed to assess TauroLock efficacy for primary TIVAP-RI prevention in low-risk cancer patients.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Taurolidine/Citrate Lock Therapy for Primary Prevention of Catheter-Related Infections in Cancer Patients: Results of a Prospective, Randomized, Phase IV<b> </b>Trial (ATAPAC)

Longo¹,

Llorens

Goetz

et al. 2017

Oncology

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“…However, the mean cost of the use of thrombolytic treatment with urokinase decreased by 45% during the TCHLS phase compared with the previous phase of heparin lock. Regarding CRBSI, several studies have shown the efficacy of TCHLS in preventing this complication in patients with cancer and in those receiving home parenteral nutrition or hemodialysis (22)(23)(24), with a low risk of resistance development (25). Handrup et al (26) showed that taurolidine significantly reduced the incidence of CRBSI compared with heparin lock but that there was no statistically significant difference in biofilm formation measured by scanning electron microscopy.…”

Section: Discussionmentioning

confidence: 99%

Tunneled Catheters with Taurolidine-Citrate-Heparin Lock Solution Significantly Improve the Inflammatory Profile of Hemodialysis Patients

Fontseré

Cardozo

Donate

et al. 2014

Antimicrob Agents Chemother

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Mortality and morbidity are significantly higher among patients with dialysis catheters, which has been associated with chronic activation of the immune system. We hypothesized that bacteria colonizing the catheter lumen trigger an inflammatory response. We aimed to evaluate the inflammatory profile of hemodialysis patients before and after locking catheters with an antimicrobial lock solution. High-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), IL-10, and tumor necrosis factor alpha (TNF-␣) were measured in serum, and levels of mRNA gene expression of IL-6, IL-10, and TNF-␣ were analyzed in peripheral blood mononuclear cells (PBMC). Samples were obtained at baseline and again after 3 months' use of taurolidinecitrate-heparin lock solution (TCHLS) in 31 hemodialysis patients. The rate of catheter-related bloodstream infections (CRBSI) was 1.08 per 1,000 catheter-days in the heparin period and 0.04 in the TCHLS period (P ‫؍‬ 0.023). Compared with the baseline data, serum levels of hs-CRP and IL-6 showed median percent reductions of 18.1% and 25.2%, respectively (P < 0.01), without significant changes in TNF-␣ or IL-10 levels. Regarding cytokine gene expression in PBMC, the median mRNA expression levels of TNF-␣ and IL-6 decreased by 20% (P < 0.05) and 19.7% (P ‫؍‬ 0.01), respectively, without changes in IL-10 expression levels. The use of TCHLS to maintain the catheter lumen sterility significantly reduces the incidence of CRBSI and improves the inflammatory profile in hemodialysis patients with tunneled catheters. Further studies are needed to evaluate the potential beneficial effects on clinical outcomes. During the last few years, switching from a catheter to an arteriovenous fistula has been shown to be associated with a substantial decrease in mortality risk (1). Some authors have demonstrated that, even in the absence of catheter-related infection, patients receiving hemodialysis through a catheter had significantly higher serum concentrations of C-reactive protein, suggesting that chronic inflammation could be the reason for their significantly higher mortality rate (2-4). However, some patients are unable to have an arteriovenous fistula and it is therefore highly important to identify the mechanism through which catheters trigger a chronic inflammatory response even in the absence of clinically evident infection.The catheter lumen is colonized by microorganisms during its insertion or as a result of manipulating the hub (5). Once the microorganisms are attached to the intraluminal surface of the catheter, they embed themselves in a matrix of extracellular polymeric substances, thereby creating a biofilm (6). The maturation of this complex structure is a dynamic process that requires a chemically controlled detachment of biofilm fragments that starts after the third day of biofilm formation (7). Dittmer et al. (8) grew blood cultures from the catheter weekly after insertion in 31 patients with a central venous hemodialysis catheter. When the central cultures became positive, indicating cat...

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“…18 Another possibility described is taurolidine lock, which, compared to heparin, is significantly more expensive. 19 Partial dysfunction of the central venous catheter is common. Fluids can be infused into the catheter, but blood cannot be aspirated.…”

Section: Discussionmentioning

confidence: 99%

The Care of Central Venous Catheters in the Oncopediatric Department

Papp

Horváth

Raț

et al. 2016

Journal of Interdisciplinary Medicine

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Introduction: Childhood cancer, with its major psycho-social and health impact, needs longterm chemotherapy. Increasing the intensity of treatment results in improved outcomes of hematological malignancies and solid tumors. As cytostatics have a vascular irritating effect and multiple peripheric venous punctures cause pain, insertion of a long-term central venous catheter (CVC) during chemotherapy is often necessary. Materials and methods: All pediatric patients (aged below 18 years) with hematologic and malignant pathologies who underwent CVC insertion at the Pediatric Hemato-oncology Department of the County Emergency Clinical Hospital of Tîrgu Mureș in the February 2014 -May 2016 period were enrolled in the study. Results: We recorded 24 cases who received central venous catheters, out of which 14 patients received tunneled CVC, 7 patients port CVC, and 3 patients received initially tunneled CVC which was changed with port CVC. Tunneled catheters were preserved in average for 186.06 days and portacaths for 256.6 days. For infection prophylaxis and treatment every child received adequate antibiotic medication. Conclusions: The use of central lines in pediatric hemato-oncology is accessible and benefic not only for increasing patient comfort, but also to ease the nurses' work, who are often overburdened.

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Central venous catheters and catheter locks in children with cancer: A prospective randomized trial of taurolidine versus heparin

Cited by 54 publications

References 33 publications

Taurolidine/Citrate Lock Therapy for Primary Prevention of Catheter-Related Infections in Cancer Patients: Results of a Prospective, Randomized, Phase IV<b> </b>Trial (ATAPAC)

Taurolidine/Citrate Lock Therapy for Primary Prevention of Catheter-Related Infections in Cancer Patients: Results of a Prospective, Randomized, Phase IV<b> </b>Trial (ATAPAC)

Tunneled Catheters with Taurolidine-Citrate-Heparin Lock Solution Significantly Improve the Inflammatory Profile of Hemodialysis Patients

The Care of Central Venous Catheters in the Oncopediatric Department

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