Taurolidine Peritoneal Dialysis Catheter Lock to Treat Relapsing Peritoneal Dialysis Peritonitis

Abstract

Peritonitis remains a primary challenge for the long-term success of peritoneal dialysis (PD) technique and one of the main reasons for catheter removal. Prevention and treatment of catheter-related infections are major concerns to avoid peritonitis. The use of taurolidine catheter-locking solution to avoid the development of a biofilm in the catheter’s lumen has obtained good results in hemodialysis catheters for reducing infection rates, although there is scarce literature available regarding its utility in PD. We describe the case of a woman in her 60s who developed relapsing peritonitis due to Pseudomonas aeruginosa , with no possibility of removing peritoneal dialysis catheter because she was not a suitable candidate for hemodialysis. After the fourth peritonitis episode caused by Pseudomonas species, the use of taurolidine catheter-locking solution was initiated. She received a total of 9 doses, with a favorable microbiological and clinical outcome and no further relapses more than 10 months after taurolidine PD catheter lock treatment was started. We report the successful elimination of an aggressive bacteria after taurolidine PD catheter lock use, with no relevant adverse events.

Spontaneous peritoneal dialysis catheter expulsion: A case series

“…Known risk factors for abdominal wall complications that could justify the lack of catheter anchoring in PD patients, such as advanced age, polycystic kidney disease or high body mass index, were not present in our series. 4 Furthermore, none of our patients had a history of abdominal surgeries or any type of damage of the abdominal wall, thus it was presumed to be normal. Possible triggers for catheter expulsion in our patients may be related to poor abdominal wall basal characteristics due to past pregnancies, chronic inflammation and catabolic state.…”

“…Intraperitoneal ceftazidime and tobramycin were started after definitive antibiogram results with good clinical outcome, but after 3 weeks antibiotics were stopped and she relapsed every time until taurolidine PD catheter lock was started (nine doses given). 4 Five months later she had an episode of exit site infection by Pseudomonas aeruginosa , solved after a course of directed antibiotics (tobramycin and ceftazidime drops as topic treatment) as well as cuff shaving and PD catheter lock with taurolidine. She did not present any signs nor symptoms of peritonitis at that point, with clear peritoneal effluent and normal cell count on PD fluid.…”

EDTA and Taurolidine Affect Pseudomonas aeruginosa Virulence In Vitro —Impairment of Secretory Profile and Biofilm Production onto Peritoneal Dialysis Catheters

“…To assess the effect of a repeated use of lock solutions, as happens in clinical practice ( 18 ) to prevent drug degradation during the management of CVC, the in vitro -contaminated PDC were exposed to a second treatment with EDTA/taurolidine solutions. As detailed above, the inhibitory effects show a trend similar to the one produced by the first treatment.…”

“…Taurolidine and calcium disodium EDTA are the most frequently prescribed antimicrobial lock solutions due to broad-spectrum activity and lack of bacterial resistance compared to standard antibiotic solutions. Promising anecdotal evidence provides clues on the successful treatment of relapsing peritonitis with taurolidine catheter-locking solution in peritoneal dialysis patients ( 16 – 18 ). Taurolidine has been effective in achieving the eradication of P. aeruginosa in PD patients with relapsing peritonitis ( 17 , 18 ).…”

“…Promising anecdotal evidence provides clues on the successful treatment of relapsing peritonitis with taurolidine catheter-locking solution in peritoneal dialysis patients ( 16 – 18 ). Taurolidine has been effective in achieving the eradication of P. aeruginosa in PD patients with relapsing peritonitis ( 17 , 18 ). There is limited experience with the use of the metal chelator EDTA as a lock solution in PD dialysis, but in vitro studies report an effective antibacterial effect of EDTA when used alone or in combination with classic antibiotics in models of P. aeruginosa infections ( 19 – 21 ) and P. aeruginosa biofilm-associated infections ( 22 – 24 ).…”