Taurolidine lock is superior to heparin lock in the prevention of catheter related bloodstream infections and occlusions.
OBJECTIVE
Patients on home parenteral nutrition (HPN) are at risk for catheter-related complications; mainly infections and occlusions. We have previously shown in HPN patients presenting with catheter sepsis that catheter locking with taurolidine dramatically reduced re-infections when compared with heparin. Our HPN population therefore switched from heparin to taurolidine in 2008. The aim of the present study was to compare long-term effects of this catheter lock strategy on the occurrence of catheter-related bloodstream infections and occlusions in HPN patients.


METHODS
Data of catheter-related complications were retrospectively collected from 212 patients who received HPN between January 2000 and November 2011, comprising 545 and 200 catheters during catheter lock therapy with heparin and taurolidine, respectively. We evaluated catheter-related bloodstream infection and occlusion incidence rates using Poisson-normal regression analysis. Incidence rate ratios were calculated by dividing incidence rates of heparin by those of taurolidine, adjusting for underlying disease, use of anticoagulants or immune suppressives, frequency of HPN/fluid administration, composition of infusion fluids, and duration of HPN/fluid use before catheter creation.


RESULTS
Bloodstream infection incidence rates were 1.1/year for heparin and 0.2/year for taurolidine locked catheters. Occlusion incidence rates were 0.2/year for heparin and 0.1/year for taurolidine locked catheters. Adjusted incidence ratios of heparin compared to taurolidine were 5.9 (95% confidence interval, 3.9-8.7) for bloodstream infections and 1.9 (95% confidence interval, 1.1-3.1) for occlusions.


CONCLUSIONS
Given that no other procedural changes than the catheter lock strategy were implemented during the observation period, these data strongly suggest that taurolidine decreases catheter-related bloodstream infections and occlusions in HPN patients compared with heparin.
Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Evelyn D
ED
Olthof
Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Michelle W
MW
Versleijen
Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
Getty
G
Huisman-de Waal
Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
Ton
T
Feuth
Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
Wietske
W
Kievit
Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Geert J A
GJ
Wanten
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D061807:Catheter Obstruction; D055499:Catheter-Related Infections / Q000517:prevention & control*; D005260:Female; D006493:Heparin / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013654:Taurine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D013829:Thiadiazines / Q000009:adverse effects / Q000494:pharmacology*; D055815:Young Adult
D013829:Thiadiazines; D013654:Taurine; C012566:taurolidine; D006493:Heparin