Randomized controlled trial of taurolidine citrate versus heparin as catheter lock solution in paediatric patients with haematological malignancies

Dümichen, M.J.; Seeger, Karl; Lode, Holger N.; Kühl, Jörn‐Sven; Ebell, Wolfram; Degenhardt, P.; Singer, Mark S.; Geffers, Christine; Querfeld, Uwe

doi:10.1016/j.jhin.2012.01.003

Cited by 69 publications

(90 citation statements)

References 12 publications

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“…The other 15 studies were excluded because of duplicates (n = 6) or due to a nonrandomized controlled study design (n = 7) or based on some other exclusion criteria (n = 2). Thus, a total of 3 studies including 236 patients with a total of 34,984 catheter days were available for analysis [27,28,29]. The characteristics of the included RCTs are shown in table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies included adult hemodialysis patients [27,29], one studied pediatric patients with hematological malignancies and catheters used for chemotherapy and intravenous medication/alimentation [28]. The inclusion and exclusion criteria for each study are shown in table 2.…”

Section: Resultsmentioning

confidence: 99%

“…The other 2 studies did not provide detailed information about the method used to generate the random allocation sequence [27,28]. …”

Section: Resultsmentioning

confidence: 99%

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Preventing Catheter-Related Bacteremia with Taurolidine-Citrate Catheter Locks: A Systematic Review and Meta-Analysis

Liu

Deng

et al. 2014

Blood Purif

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Background: Preliminary evidence from some studies suggests that taurolidine-citrate locks decrease catheter-related bacteremia (CRB), which is a major cause of morbidity and mortality in patients using intravascular catheters. No previous study has sought to summarize existing evidence on the use of taurolidine-citrate locks. A systematic review and meta-analysis were undertaken to determine whether taurolidine-citrate was more effective than heparin in the prevention of CRB. Methods: The major English (PubMed, EBSCO, Web of Science and OVID) and Chinese (CBM, CNKI, VIP and Wanfang Data) healthcare databases were searched for randomized controlled trials comparing the efficacy and safety of taurolidine-citrate lock solution (TCLS) and heparin lock solution in the prevention of CRB. Results: Three studies involving 236 patients with a total of 34,984 catheter days were included. The use of TCLS significantly decreased the risk of CRB (relative risk = 0.47, 95% CI: 0.25-0.89) and Gram-negative bacterial infection. There was no significant difference in Gram-positive infections and exit-site infections. Conclusions: Catheter locking with TCLS reduced the risk of CRB and Gram-negative bacterial infection. Adverse events include thrombotic events.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Preventing Catheter-Related Bacteremia with Taurolidine-Citrate Catheter Locks: A Systematic Review and Meta-Analysis

Liu

Deng

et al. 2014

Blood Purif

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“…Our study is not in the position to address this statement, since port systems were observed only until the first appearing complication. In a pediatric study involving children with hematological diseases, taurolidine citrate was able to bring about a significant reduction in catheter-related sepsis [32]. A systematic survey study likewise demonstrated the advantage of heparin-or antibioticcoated catheters over non-coated catheters [33].…”

mentioning

confidence: 95%

Evaluation of Correlations between Underlying Disease and Port Complications

Teichgräber¹,

Nagel²,

Kausche³

2014

Fortschr Röntgenstr

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Purpose: Evaluation of correlations between underlying disease and port complications. Materials and Methods: Retrospective analysis of a data set of 3160 port systems, which had been interventionally implanted over a period of 10 years. Of these, 1393 were included in the final evaluation. The 7 most common underlying diseases and port-induced complications were considered. Port-related thrombotic events, port pocket infections as well as the port-induced sepsis were evaluated and classified as either early or late complications. Results: In 1393 ports, 131 experienced complications. Of these, 22.1?% (n?=?29) were early and 79.6?% (n?=?102) late complications. The overall incidence rate of late complications was 0.253/1000 observed days. It differed significantly between the underlying diseases (p?

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“…Fewer catheter occlusion complications or other adverse reactions were reported for the 7% citrate lock composition than for the heparin lock control in this study. Another trial reported a significant reduction in infections in immunocompromised pediatric patients with a 1.35% taurolidine-4% citrate lock versus the number with heparin; however, 20% of the taurolidine-citrate group reported side effects (15).…”

Section: Discussionmentioning

confidence: 99%

Glyceryl Trinitrate Complements Citrate and Ethanol in a Novel Antimicrobial Catheter Lock Solution To Eradicate Biofilm Organisms

Rosenblatt

Reitzel

Dvorak

et al. 2013

Antimicrob Agents Chemother

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Antimicrobial catheter lock therapy is practiced to prevent lumenal-sourced infections of central venous catheters. Citrate has been used clinically as an anticoagulant in heparin-free catheter locks. Ethanol has also been widely studied as an antimicrobial lock solution component. This study reports on the synergy of glyceryl trinitrate (GTN) with citrate and ethanol in rapidly eradicating methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermidis, Pseudomonas aeruginosa, and Candida albicans biofilms in an in vitro model for catheter biofilm colonization. GTN has a long history of intravenous use as a hypotensive agent. It is potentially attractive as a component of a catheter lock solution because its physiologic half-life is quite short and its metabolic pathways are known. A lock containing 7% citrate and 20% ethanol required 0.01% GTN to fully eradicate biofilms of all test organisms within 2 h in the model. This GTN concentration is below the levels where clinically significant hypotensive effects are expected. Central line-associated bloodstream infections (CLABSIs) have declined over the past decade but remain a significant medical problem, with a substantial cost burden to the health care system. There are an estimated 250,000 CLABSIs in the United States (1), with an estimated treatment cost of $45,000 or more per infection (2). Significant portions of CLABSIs annually are associated with hemodialysis treatment (3) and treatment of critically ill patients. CLABSIs that present after the first week of catheterization tend to be associated with colonization of the catheter lumenal surfaces (4, 5) and biofilm formation on those surfaces. Colonizing organisms organize within hours into biofilm structures which can serve as a source of CLABSI and can be highly resistant to eradication by antibiotic treatments. Approaches to reducing lumenal colonization include rigorous provider hygiene and use of antimicrobial swabs when connectors are manipulated. Even with these precautions, much of the lumenal surfaces remain vulnerable to colonization. Another approach to combatting lumenal infections has been the use of antimicrobial lock therapy (ALT). Catheter lumens are hydraulically locked when not in use. Typically, lock solutions include anticoagulants to inhibit the formation of blood clots, which can occlude flow through catheters. Heparin has traditionally been used as an anticoagulant; however, there have been concerns about its purity (6), as well as its potential to promote bacterial biofilm colonization (7). Antimicrobial locks have generally fallen into the categories of antibiotic locks and nonantibiotic, antiseptic locks. Antibiotic locks have been pursued both for catheter salvage and for infection prevention. Antibiotic catheter locks have recently been reviewed (8). Significant issues limiting the use of antibiotic locks for prevention are their higher costs and potential to promote the development of antibiotic resistance. We report here on the utility of glycery...

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Randomized controlled trial of taurolidine citrate versus heparin as catheter lock solution in paediatric patients with haematological malignancies

Cited by 69 publications

References 12 publications

Preventing Catheter-Related Bacteremia with Taurolidine-Citrate Catheter Locks: A Systematic Review and Meta-Analysis

Preventing Catheter-Related Bacteremia with Taurolidine-Citrate Catheter Locks: A Systematic Review and Meta-Analysis

Evaluation of Correlations between Underlying Disease and Port Complications

Glyceryl Trinitrate Complements Citrate and Ethanol in a Novel Antimicrobial Catheter Lock Solution To Eradicate Biofilm Organisms

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