Efficacy of intravascular catheter lock solutions containing preservatives in the prevention of microbial colonization

Abstract

SUMMARY There is little published evidence regarding whether heparin lock solutions containing preservatives prevent catheter-related infections. However, adverse effects from preservative-containing flushes have been documented in neonates, leading many hospitals to avoid their use altogether. Infection control records from 1982 to 2008 at St. Jude Children’s Research Hospital (SJCRH) were reviewed regarding the incidence of CRIs and the use of preservative-containing intravenous locks. In addition, the antimicrobial activities of heparin lock solution containing the preservatives parabens (0.165%) or benzyl alcohol (0.9%), and 70% ethanol were examined against Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, Bacillus cereus, Pseudomonas aeruginosa and Candida albicans, and compared with preservative-free saline with and without heparin. Growth was assessed after exposure to test solutions for 0, 2, 4 and 24 h at 35°C. The activities of preservatives were assessed against both planktonic (free-floating) and sessile (biofilm-embedded) micro-organisms using the MBEC Assay. Infection control records revealed two periods of increased catheter-related infections, corresponding with two intervals when preservative-free heparin was used at SJCRH. Heparin solution containing preservatives demonstrated significant antimicrobial activity against both planktonic and sessile forms of all six microbial species. Ethanol demonstrated the greatest antimicrobial activity, especially following short incubation periods. Heparin lock solutions containing the preservatives parabens or benzyl alcohol, and 70% ethanol demonstrated significant antimicrobial activity against both planktonic and sessile micro-organisms commonly responsible for CRIs. These findings, together with the authors’ historical infection control experience, support the use of preservatives in intravenous lock solutions to reduce catheter related infections in patients beyond the neonatal period.

Bloodstream infection in paediatric cancer centres—leukaemia and relapsed malignancies are independent risk factors

“…As well, it has to be considered that taurolidine-containing antimicrobial CVAD locks are only applied when the CVAD is not in use. A randomised multicentre study, investigating the effect of taurolidine or other innovative antimicrobial lock solutions [16,46] is warranted. The preventive potential of routine taurolidine locks may be of particular interest in paediatric cancer patients receiving home parenteral nutrition [9].…”

Stability and compatibility of antimicrobial lock solutions

“…A 30% ethyl alcohol/4% TSC solution and a solution of 70% ethyl alcohol and heparin sodium 10 units/mL have been evaluated over 24, 48, and 72 hours, with no reports of incompatibilities. 10,11,91 The stability and compatibility of ethyl alcohol with higher concentrations of heparin have not been investigated.…”

“…91 Ethyl alcohol-containing solutions are inexpensive and appear to be effective for use in prophylactic lock regimens. 10,11,91,95,96 Due to increases in bacterial resistance, novel options such as ethyl alcohol-based lock solutions may be a preferred option.…”

“…1 Heparin is the most commonly used anticoagulant additive in ALT, but other compounds, including trisodium citrate (TSC) and ethylenediaminetetraacetic acid (EDTA), which work synergistically with most antiinfectives, as well as thrombolytics, have been studied. [5][6][7][8][9][10][11] Because of the increase in ALT utilization in both inpatient and outpatient settings and the continuing emergence of novel lock solutions, it is imperative that concise and validated stability and compatibility data are available to practitioners. This review details the available stability and compatibility data from evaluations of antimicrobial lock solutions used in combination with anticoagulants or other additives and provides recommendations for clinical application.…”

Searching for new strategies against polymicrobial biofilm infections: guanylated polymethacrylates kill mixed fungal/bacterial biofilms

“…coagulasenegative staphylococci) 47 and has been studied in vitro against monomicrobial and polymicrobial biofilms formed by C. albicans or S. aureus. 18,48,49 Although ethanol has advantages, there are concerns about side effects when used as an antimicrobial lock solution, such as systemic toxicity, damage to the catheter materials and the related intraluminal obstruction and thrombosis. 43,47 Given this, it is of interest to develop new approaches, such as what we demonstrate here with guanylated polymethacrylates.…”