Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution

Betjes, Michiel G. H.; Agteren, Madelon van

doi:10.1093/ndt/gfh014

Cited by 199 publications

(194 citation statements)

References 18 publications

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“…The results are comparable to the outcomes reported in earlier trials involving antimicrobial locking solutions for the prevention of CRBSI among hemodialysis (HD) patients [6][7][8][9][10][11][12] (Fig. 1).…”

supporting

confidence: 85%

Editorial: The Issues Related to Hemodialysis Catheter Lock Prophylaxis with Recombinant Tissue Plasminogen Activator

Saxena¹

2011

TOUNJ

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Arteriovenous fistulas (AVF) are the most preferred and promoted form of dialysis access due to their lowest complication rates. However, the changing demographic profile of end-stage renal disease (ESRD) with an increasing elderly and diabetic population having relatively poor vasculature, relative lack of prudent pre-ESRD planning for AV fistula creation, late referrals, and comparatively lower fistula maturation rates, are essentially the factors accountable for our continued dependence upon central venous catheters (CVCs) [1][2][3]. Moreover, CVCs remain the only means to provide instant access to the circulation during emergency situations arising from the unpredictable course of chronic kidney disease.Virchow's described three broad categories of factors that contribute to thrombus formation -hypercoagulability, stasis and vascular endothelial injury. The placement of this relatively large foreign body traumatizes the host vessel and significantly alters hemodynamics fulfilling Virchow's triad for thrombus formation and provides a nidus for bacterial entry into the circulation. However, catheter malfunction limits the life span of CVCs. Inadequate blood flow and catheter-related bloodstream infections (CRBSI) are common causes of recurrent use of thrombolytic therapy, antibiotics and often result in catheter removal. Generally, standard heparin (5000 U/ mL) is used to lock the CVCs to maintain catheter patency during the interdialytic period. Locking with heparin however, does not prevent bacterial colonization and subsequent development of CRBSI. Moreover, in vitro studies have shown that heparin may induce biofilm formation [4].Replacing heparin with recombinant tissue plasminogen activator (rt-PA) once a week, as a dialysis catheter locking solution significantly reduced the incidence of catheter malfunction and CRBSI in a well conducted multicenter, double-blind, randomized controlled trial from Canada by Hemmelgarn and colleagues [5]. The authors were able to decrease the rates of catheter malfunction by 50% and

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supporting

confidence: 85%

Editorial: The Issues Related to Hemodialysis Catheter Lock Prophylaxis with Recombinant Tissue Plasminogen Activator

Saxena¹

2011

TOUNJ

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“…Betjes and van Agteren evaluated the effect of this AML in patients with newly placed TCCs. Patients of the taurolidine−citrate group had a lower CRB rate compared with patients on heparin lock and had no increased requirement for thrombolytic interventions to maintain catheter patency [66], as was described by Allon [43]. Further studies, possibly with the addition of heparin to AML, might determine whether catheter patency can be improved.…”

Section: B Preventing Contamination Of the Catheter Hubmentioning

confidence: 74%

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Stefanidis

2009

Pediatr Nephrol

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This editorial commentary discusses the strategies for prevention of catheter-related bacteremia (CRB) in children on hemodialysis, which is associated with high morbidity and the increase of hospital cost. There is evidence that the use of arteriovenous fistulae in children on hemodialysis is associated with lower infection rates. Therefore, the use of catheters in these patients should be decreased by improving arteriovenous fistulae use rates or by increasing peritoneal dialysis patient recruitment. However, despite the wide adoption of such policies, hemodialysis catheters are still being used in a significant number of cases. For these patients, implementation of effective strategies for preventing contamination of the catheter hub should be a priority. The appropriate recording and evaluation of CRB rates are important for assessing preventive policies. In addition, the successful management of a CRB is essential for preventing recurrence of bacteremia. Recently it was documented in a number of randomized clinical trials that antimicrobial lock solutions were effective for preventing CRB. It is suggested that the use of antimicrobial locks should be considered in children who are at high risk of developing CRB, with caution for their long-term use, because of the possibility of bacterial resistance. Now is the time for action, and all preventive steps should be performed simultaneously to minimize the risk of CRB.

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“…Unfortunately, currently available alternative locks all have ongoing questions and concerns beyond their rather limited study data. Taurolidine with 4% sodium citrate has been shown to be effective in several studies but may be associated with an increase in catheter thrombosis and is not currently available in the United States (7,32,33). High-dose citrate (30 to 47%) has been well studied but is complicated by the rare but fatal risk of hypocalcemia that led to the FDA's recall of 47% citrate in 2000 (3,9).…”

Section: Discussionmentioning

confidence: 99%

“…Numerous randomized, controlled trials (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), as well as meta-analyses of these studies (21)(22)(23)(24)(25), have been performed during the past decade to evaluate the benefit of anti-microbial lock solutions in chronic hemodialysis patients with TCCs. These studies have been heterogeneous in nature and used different antibiotics (gentamicin, minocycline, cefazolin, cefotaxime, vancomycin) and nonantibiotic (citrate, taurolidine, EDTA) anti-microbial lock solutions; however, they have all shown a significant decline of 50 to 100% in CRIs compared with standard heparin lock without antibiotics or other sterilizing solutions (3).…”

mentioning

confidence: 99%

Emergence of Gentamicin-Resistant Bacteremia in Hemodialysis Patients Receiving Gentamicin Lock Catheter Prophylaxis

Landry

Braden

Gobeille

et al. 2010

Clinical Journal of the American Society of Nephrology

135

105

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Results: Within the first year of the GHL protocol, our CRI rate decreased from 17 to 0.83 events per 1000 catheter-days. Beginning 6 months after initiation of the GHL protocol, febrile episodes occurred in 13 patients with coagulase-negative Staphylococcus bacteremia resistant to gentamicin. Over the 4 years of GHL use, an additional 10 patients developed 11 episodes of gentamicin-resistant CRI (including 7 with Enterococcus faecalis), in which there were 4 deaths, 2 cases of septic shock requiring intensive care unit admission, and 4 cases of endocarditis. Because of these events, the GHL protocol was discontinued at the end of 2006.Conclusions: Although the use of GHL effectively lowered the CRI rate in our dialysis population, gentamicin-resistant CRIs emerged within 6 months. Gentamicin-resistant infections are a serious complication of the long-term use of GHLs. Alternative nonantibiotic catheter locks may be preferable to decrease the incidence of CRIs without inducing resistant pathogens.

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Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution

Cited by 199 publications

References 18 publications

Editorial: The Issues Related to Hemodialysis Catheter Lock Prophylaxis with Recombinant Tissue Plasminogen Activator

Editorial: The Issues Related to Hemodialysis Catheter Lock Prophylaxis with Recombinant Tissue Plasminogen Activator

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Emergence of Gentamicin-Resistant Bacteremia in Hemodialysis Patients Receiving Gentamicin Lock Catheter Prophylaxis

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