Clinical outcomes of home parenteral nutrition patients using taurolidine as catheter lock: A long-term cohort study

Wouters, Yannick; Roosenboom, Britt; Causevic, Erna; Kievit, Wietske; Groenewoud, Hans; Wanten, Geert

doi:10.1016/j.clnu.2018.09.020

Cited by 22 publications

(21 citation statements)

References 41 publications

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“…The currently available literature on this topic remains controversial and is mainly based on retrospective studies in adult patients with CVADs, not always necessarily inserted for the purpose of HPN support. This is exemplified by the equivocal results of studies: 5 reported a protective effect on CRBSIs in patients using subcutaneous port systems, 3 found the opposite, and 5 did not observe a difference between the 2 CVAD types . Recent guidelines from the American Society for Parenteral and Enteral Nutrition (ASPEN) state that subcutaneous port systems are primarily intended for low‐frequency and intermittent venous access .…”

Section: Discussionmentioning

confidence: 99%

Use of Catheter Lock Solutions in Patients Receiving Home Parenteral Nutrition: A Systematic Review and Individual‐Patient Data Meta‐Analysis

Wouters

Causevic

Kłęk³

et al. 2020

J Parenter Enteral Nutr

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Background Use of catheter lock solutions (CLSs) as a strategy to prevent catheter‐related bloodstream infections (CRBSIs) has been evaluated in recent clinical trials. Our aim was to identify the most effective CLS formulation in patients receiving home parenteral nutrition (HPN). Methods We conducted a systematic review and individual‐patient data meta‐analysis (IPDMA). Prospective randomized clinical trials in adult HPN patients using CLS were identified from PubMed, EMBASE, Web of Science, CINAHL, Cochrane library, and ClinicalTrials.gov. Primary outcome was the number of CRBSIs per 1000 catheter days for each CLS. Other outcomes included time to CRBSI and identification of patients with a higher risk for CRBSIs. Results In total, 1107 studies were screened for eligibility, of which three studies comprising 162 HPN patients and 45,695 catheter days were included in the IPDMA. CRBSI rates were significantly decreased in patients using taurolidine (rate 0.13; 95% confidence interval [CI], 0.05–0.32) when compared with saline (rate 0.74; 95% CI, 0.31–1.74; P = .002) or heparin (rate 2.01; 95% CI, 1.03–3.91; P < .001). The cumulative proportion of CRBSI‐free patients using taurolidine, saline, and heparin after 1 year was 88%, 56%, and 14%, respectively. Three risk factors for CRBSIs were identified: type of CLS, intestinal dysmotility as underlying condition, and use of central venous catheters. Conclusions Taurolidine was the most effective CLS formulation in HPN patients for the prevention of CRBSIs. We suggest discussing with patients the benefits and risks when starting taurolidine, especially in patients who are considered to have a higher risk for CRBSIs.

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Section: Discussionmentioning

confidence: 99%

Use of Catheter Lock Solutions in Patients Receiving Home Parenteral Nutrition: A Systematic Review and Individual‐Patient Data Meta‐Analysis

Wouters

Causevic

Kłęk³

et al. 2020

J Parenter Enteral Nutr

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“…ESPEN guidelines for CIF were published in 2016. Since then, no additional relevant literature was found concerning the above recommendations, but two high quality double blinded RCTs [151,152] and one extensive retrospective analysis [153] have been published on antimicrobial CVAD locking with various taurolidine formulations, that have considerably changed the available body of evidence and the strength of recommendation about the use of taurolidine for the prevention of CRBSI. All studies were performed in the setting of HPN support for adult benign CIF.…”

Section: Recommendation 34mentioning

confidence: 99%

“…Wouters et al also retrospectively analyzed long-term complications and adverse events in adult HPN patients from a national referral center who all used taurolidine locks between 2006 and 2017 [153]. In total, 270 HPN patients used taurolidine during 338.521 catheter days.…”

Section: Recommendation 34mentioning

confidence: 99%

ESPEN guideline on home parenteral nutrition

et al. 2020

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This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion line and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN.

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“…This treatment strategy is coined as home parenteral nutrition (HPN) support, and it centers on self‐management of central venous access devices (CVADs) by patients or their caregivers. Patients receiving HPN have an increased risk for central line–associated bloodstream infections (CLABSIs), 8%–15% of which are caused by Candida species . Candidemia is infamously known for its substantial morbidity and mortality rates of up to 40%, also due to the tendency for metastatic spread, with an obvious impact on patient quality of life and healthcare resources .…”

Section: Introductionmentioning

confidence: 99%

“…Patients receiving HPN have an increased risk for central line-associated bloodstream infections (CLABSIs), 8%-15% of which are caused by Candida species. [1][2][3] Candidemia is infamously known for its substantial morbidity and mortality rates of up to 40%, also due to the tendency for metastatic spread, with an obvious impact on patient quality of life and healthcare resources. [4][5][6][7][8][9][10][11] To prevent dissemination of fungal pathogens, timely removal of CVADs is crucial.…”

Section: Introductionmentioning

confidence: 99%

Contribution of Genetic and Clinical Risk Factors to Development of Candidemia in Patients Receiving Home Parenteral Nutrition

Wouters

Roelofs

Netea

et al. 2019

J Parenter Enteral Nutr

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Background Patients receiving home parenteral nutrition (HPN) have an increased risk for central line–associated bloodstream infections (CLABSIs), including candidemia. Recently, 7 single‐nucleotide polymorphisms (SNPs) in TLR1, CD58, LCE4A‐Clorf68, and TAGAP have been associated with the development of candidemia. Identification of host‐genetic as well as clinical risk factors may help to identify patients who have an increased susceptibility to such infections. The aim of this study was to investigate the relevance of the reported SNPs in patients receiving HPN, and to explore clinical risk factors associated with candidemia. Methods We analyzed blood samples of adult patients who started HPN between 1976 and 2017 at our referral center for intestinal failure. Primary outcome was the association between TLR1, CD58, LCE4A‐Clorf68, or TAGAP SNPs and candidemia. Secondary outcomes included the relation between severity of infection and these SNPs, and clinical risk factors for candidemia. Results Of 341 included patients, 42 (12%) experienced a candidemia (range 1–6). None of the 7 SNPs were associated with candidemia or the severity of infection. The rate of non‐Candida‐related CLABSIs was significantly associated with candidemia (rate ratio, 1.29; 95% CI, 1.14–1.46; P < 0.001). Conclusions None of 7 known SNPs in TLR1, CD58, LCE4A‐Clorf68, or TAGAP were associated with candidemia or severity of infection in patients receiving HPN. The rate of non‐Candida‐related CLABSIs was significantly associated with the development of candidemia. The latter supports the key role of aseptic catheter handling with respect to Candida susceptibility in patients receiving HPN.

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Clinical outcomes of home parenteral nutrition patients using taurolidine as catheter lock: A long-term cohort study

Cited by 22 publications

References 41 publications

Use of Catheter Lock Solutions in Patients Receiving Home Parenteral Nutrition: A Systematic Review and Individual‐Patient Data Meta‐Analysis

Use of Catheter Lock Solutions in Patients Receiving Home Parenteral Nutrition: A Systematic Review and Individual‐Patient Data Meta‐Analysis

ESPEN guideline on home parenteral nutrition

Contribution of Genetic and Clinical Risk Factors to Development of Candidemia in Patients Receiving Home Parenteral Nutrition

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