title: Superior antimicrobial activity of trisodium citrate over heparin for catheter locking.
abstract: BACKGROUND
  Haemodialysis catheters used for vascular access are frequently complicated by infection and catheter-related thrombosis. Improvement of interdialytic locking solutions could reduce these problems. Trisodium citrate (TSC) has been advocated in recent years because it might have antimicrobial qualities.
  
  
  METHODS
  Antimicrobial efficacy of four concentrations of TSC (2.2, 7.5, 15 and 30%) was compared with three equi-osmolal sodium chloride (NaCl) concentrations, unfractionated heparin 5000 IU/ml and a solution of gentamicin 1 mg/ml in TSC 7.5%. We analysed antimicrobial properties by two classical in vitro susceptibility tests. All tests were performed in triplicate by incubation of test fluids with Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa and Candida albicans.
  
  
  RESULTS
  Increasing TSC concentrations effectively killed the staphylococcal strains in both assays. For E.coli and P.aeruginosa complete killing was achieved only with TSC 30%. TSC 30% was also the only solution that significantly inhibited growth of C.albicans. Heparin manifested no antimicrobial effect of any significance. Adding gentamicin to TSC provided superior bacterial growth inhibition but had no effect on yeast growth. TSC solutions manifested superior antimicrobial activity compared with iso-osmolal NaCl solutions in both assays.
  
  
  CONCLUSIONS
  This in vitro study demonstrates superior antimicrobial activity of TSC, especially in higher concentrations, in contrast to heparin. The mechanism seems to differ from hyperosmolality. Ca(2+) and Mg(2+) chelating effects are probably more important. Adding gentamicin provided the most potent antimicrobial solution. However, for reasons concerning development of bacterial resistance and sensitization of the patient, continuous exposition to aminoglycosides seems not advisable.
authors.affiliation: Department of Nephrology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands. mc.weijmer@vumc.nl
authors.forename: Marcel C
authors.initials: MC
authors.lastname: Weijmer
authors.forename: Yvette J
authors.initials: YJ
authors.lastname: Debets-Ossenkopp
authors.forename: Francien J
authors.initials: FJ
authors.lastname: Van De Vondervoort
authors.forename: Piet M
authors.initials: PM
authors.lastname: ter Wee
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002176:Candida albicans / Q000187:drug effects; D002408:Catheters, Indwelling / Q000382:microbiology*; D002951:Citrates / Q000494:pharmacology*; D006493:Heparin / Q000494:pharmacology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D009994:Osmolar Concentration; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012965:Sodium Chloride / Q000494:pharmacology; D000077559:Sodium Citrate; D013211:Staphylococcus aureus / Q000187:drug effects; D013212:Staphylococcus epidermidis / Q000187:drug effects; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D002951:Citrates; C514290:trisodium citrate; D000077559:Sodium Citrate; D012965:Sodium Chloride; D006493:Heparin