title: 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.
abstract: Catheter-related blood stream infections may be reduced by interdialytic locking with Taurolidine, a nontoxic antimicrobial agent. A formulation of 1.35% Taurolidine in 4% citrate (TC) is associated with a greater need for thrombolysis to maintain catheter patency than 5000 U/ml heparin. Our aim was to determine whether addition of 500 Units/ml of heparin to TC reduces the need for thrombolysis. TCH (1.35% taurolidine, 4% citrate and 500 U/ml heparin) was compared to TC and Heparin 5000 U/ml using retrospective data. Hundred and six adult hemodialysis patients with internal jugular tunnelled intravascular catheters using TCH were compared with 34 patients using TC and 34 patients using heparin 5000 U/ml respectively. Outcomes were time to first use of thrombolysis and bacteremia rates.TCH reduced the need for thrombolysis compared to TC (hazard ratio, 0.2; 95%CI: 0.06, 0.5; p < 0.001) and was not significantly different from heparin 5000 U/ml (hazard ratio, 1.4; 95%CI: 0.5, 3.9; p = 0.5). The bacteremia rates from all causes were 1.33, 1.22 and 3.25 per 1000 catheter- days (p < 0.001) in the TCH, TC and heparin groups respectively. Addition of 500 U/ml heparin to TC reduces the need for thrombolysis without increasing bacteremia and may achieve patency comparable to heparin 5000 U/ml.
authors.affiliation: Renal Unit, Lancashire Teaching Hospitals, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, Lancashire, UK. laurie.solomon@lthtr.nhs.uk
authors.forename: Laurie R
authors.initials: LR
authors.lastname: Solomon
authors.forename: John S
authors.initials: JS
authors.lastname: Cheesbrough
authors.forename: Ramya
authors.initials: R
authors.lastname: Bhargava
authors.forename: Nicos
authors.initials: N
authors.lastname: Mitsides
authors.forename: Michael
authors.initials: M
authors.lastname: Heap
authors.forename: Gerwyn
authors.initials: G
authors.lastname: Green
authors.forename: Peter
authors.initials: P
authors.lastname: Diggle
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D019343:Citric Acid / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013829:Thiadiazines / Q000627:therapeutic use*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
chemical_list: D000890:Anti-Infective Agents; D000925:Anticoagulants; D013829:Thiadiazines; D013654:Taurine; D019343:Citric Acid; C012566:taurolidine; D006493:Heparin