Antifungal activity of Taurolidine against Mucorales: an in-vitro study on clinical isolates

Abstract

Background and Purpose: Taurolidine is active against a wide variety of microorganisms, including bacteria and fungi. Mucormycosis is one of the life-threatening opportunistic fungal infections, especially in immunocompromised patients. Currently, the emergence of Mucormycosis during the COVID-19 pandemic raises public health concerns regarding untoward morbidity and mortality among SARS-CoV-2 patients. It is well-known that delayed and inappropriate antifungal therapy leads to increased morbidity and mortality. This study aimed to investigate the in-vitro antifungal activity of taurolidine to evaluate its effects against clinical isolates of Mucorales.
 Materials and Methods: This study included previously collected clinical Mucorales isolates. The minimum in vitro inhibitory concentration (MIC) of amphotericin B, caspofungin, voriconazole, posaconazole, and itraconazole was determined using the broth microdilution method.
 Results: All clinical isolates showed full sensitivity to amphotericin B. Posaconazole MIC range from 8 μg/mL to 0.032 μg/mL. The MIC range of voriconazole and caspofungin were determined to be 2-8 µg/mL and 0.5-16 µg/mL, respectively. Growth of the isolates was entirely inhibited in 1000 µg/mL concentration of taurolidine. In microscopic observations, morphological effects on hyphal growth were observed at 500 µg/mL concentration.
 Conclusion: In conclusion, this is an updated experience of using taurolidine against Mucorales. However, our in-vitro findings need to be confirmed in well-designed clinical trials aimed at treating invasive Mucormycosis infections

Taurolidine and Heparin as Catheter Lock Solution for Central Venous Catheters in Hemodialysis

“…LOCK IT-100 trial [31][32][33][34] LOCK IT-100 was a large, randomized, double-blind, active-control, multicenter, phase 3 study (Table 2). 66 Adult patients with kidney failure receiving hemodialysis through permanent tunneled cuffed catheter were randomized in 1:1 ratio to either taurolidine and heparin or heparin.…”

“…Winniki study [31][32][33][34] This is a prospective, multicenter, randomized, controlled trial, comparing 2 lock solutions (taurolidine vs. citrate) (Table 2). 67 In the taurolidine group, TauroLock-Hep500 twice per week and TauroLock-U25,000 once a week were used, and citrate 4% was used after each dialysis.…”

“…Murray study [31][32][33][34] In this large, observational, hemodialysis cohort, lock therapy with taurolidine 1.35%, citrate 4%, and heparin 500 units/mL (taurolidine-citrate-heparin) was compared with a retrospective cohort of patients given heparin 5000 units/mL for TCVC lock, assessing the impact on the rates of staphylococcal BSI (Table 2). 69 Following conversion to taurolidine-citrate-heparin, the rate ratio of staphylococcal bacteremic events in the TCVC group was 0.42 (95% CI 0.35, 0.50, P , 0.01) over the observation period.…”

“…Summary of taurolidine in vitro activity against various pathogenic microbes reported in the literature [31][32][33][34]. …”

In vitro activity of taurolidine against clinical Candida auris isolates: relevance to catheter-related bloodstream infections

“…and for the mycelial fungal pathogen, Mucor spp. ( 15 , 19 ). When considering the MICs, one would generally relate these values to clinically available breakpoints.…”