A randomized double-blind controlled trial of taurolidine-citrate catheter locks for the prevention of bacteremia in patients treated with hemodialysis.
BACKGROUND
Bacteremia is a major cause of morbidity in patients using intravascular catheters. Interdialytic locking with antibiotics decreases the incidence of bacteremia, but risks antibiotic resistance. Taurolidine is a nontoxic broad-spectrum antimicrobial agent that has not been associated with resistance. Preliminary evidence suggests that taurolidine-citrate locks decrease bacteremia, but cause flow problems in established catheters.


METHODS
Double-blind randomized controlled trial.


METHODS
Interdialytic locking with taurolidine and citrate (1.35% taurolidine and 4% citrate) compared with heparin (5,000 U/mL) started at catheter insertion.


METHODS
110 adult hemodialysis patients with tunneled cuffed intravascular catheters inserted at 3 centers in Northwest England.


METHODS
Primary end points were time to first bacteremia episode from any cause and time to first use of thrombolytic therapy.


RESULTS
There were 11 bacteremic episodes in the taurolidine-citrate group and 23 in the heparin group (1.4 and 2.4 episodes/1,000 patient-days, respectively; P = 0.1). There was no significant benefit of taurolidine-citrate versus heparin for time to first bacteremia (hazard ratio, 0.66; 95% CI, 0.2-1.6: P = 0.4). Taurolidine-citrate was associated with fewer infections caused by Gram-negative organisms than heparin (0.2 vs 1.1 infections/1,000 patient-days; P = 0.02); however, there was no difference for Gram-positive organisms (1.1 vs 1.2 infections/1,000 patient-days; P = 0.8). There was a greater need for thrombolytic therapy in the taurolidine-citrate versus heparin group (hazard ratio, 2.5; 95% CI, 1.3-5.2; P = 0.008).


CONCLUSIONS
Small sample size. The study included bacteremia from all causes and was not specific for catheter-related bacteremia.


CONCLUSIONS
Taurolidine-citrate use did not decrease all-cause bacteremia and was associated with a greater need for thrombolytic treatment. There was a decrease in infections caused by Gram-negative organisms and a trend to a lower frequency of bacteremia, which warrants further study.
Solomon
Laurie R
LR
Renal Unit, Lancashire Teaching Hospitals, Royal Preston Hospital, Lancashire, UK. laurie.solomon@lthtr.nhs.uk
Cheesbrough
John S
JS
Ebah
Leonard
L
Al-Sayed
Tamer
T
Heap
Michael
M
Millband
Nick
N
Waterhouse
Dee
D
Mitra
Sandip
S
Curry
Alan
A
Saxena
Rema
R
Bhat
Rammohan
R
Schulz
Michael
M
Diggle
Peter
P
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000382:microbiology*; D019343:Citric Acid / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013829:Thiadiazines / Q000627:therapeutic use*
D000890:Anti-Infective Agents; D000925:Anticoagulants; D013829:Thiadiazines; D013654:Taurine; D019343:Citric Acid; C012566:taurolidine; D006493:Heparin