Prevention of Hemodialysis Catheter-Related Bloodstream Infection Using an Antimicrobial Lock

Abstract

Among currently available vascular access options for hemodialysis, central venous catheters show the poorest reliability, with frequent complications of thrombosis and stenosis impairing patency. The most serious problem, however, is catheter-related bloodstream infection (CRBI), which is typically a cause for removal of the catheter and protracted systemic antibiotic therapy. In our experience, a totally implanted device (Dialock^®, Biolink Corp.) seems to confer a better global protection against catheter-related infections than standard tunneled catheters, accounting for 0.97 vs. 4.75 infection episodes/1,000 catheter-days, respectively (p < 0.001). Bloodstream infection rates, however, are not statistically different in the two groups (0.85 vs. 0.81 per 1,000 catheter-days; p = n.s.), indicating that the improvement is mainly related to local cutaneous infections. On the other hand, in the Sodemann experience, a new taurolidine-based lock solution (Neutrolin^®, Biolink Corp.) greatly reduced CRBI rates with both subcutaneous ports and tunneled catheters to 0.29 and 0.20 episodes/1,000 catheter-days, respectively. These promising results await further confirmation from ongoing clinical trials.

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

“…Studies have found that taurolidine works by reducing the biofilm formation . A subgroup of the CVCs included in this study was also examined by scanning electron microscopy and no difference was found in the biofilm development between the two groups .…”

Use of Vancomycin-Containing Lock or Flush Solutions for Prevention of Bloodstream Infection Associated with Central Venous Access Devices: A Meta-Analysis of Prospective, Randomized Trials

“…Our search yielded 63 published reports (figure 1); 56 studies were excluded because they evaluated lock solutions other than vancomycin [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46], did not have a control group [47][48][49][50], used a lock solution for treatment rather than prevention [45,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65], did not use a randomized, controlled study design [66][67][68][69], assessed the utility of a lock solution for prevention of BSI with only 1 type of organism [70], were reviews [19,20,56,[71][72][73][74][75]...…”

Observational Study of Need for Thrombolytic Therapy and Incidence of Bacteremia using Taurolidine‐Citrate‐Heparin, Taurolidine‐Citrate and Heparin Catheter Locks in Patients Treated with Hemodialysis

“…Taurolidine is a broad-spectrum antimicrobial agent that has been reported to reduce bacteremia rates in patients with hemodialysis, nutrition and pediatric catheters (11)(12)(13). It acts by a direct effect on bacterial cell walls and has never been associated with resistance (12,(14)(15)(16).…”