Relapsing peritonitis and taurolidine peritoneal catheter lock: One center experience

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> Relapsing peritonitis due to the development of a biofilm in the catheter’s lumen remains an important complication of peritoneal dialysis therapy that endangers technique continuity. Taurolidine catheter lock has proven efficient reducing infection rates in permanent hemodialysis catheters based on its biocidal activity and biofilm detachment effect. Efficacy evidence on its use in peritoneal dialysis catheters is lacking. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We retrospectively analyzed all relapsing peritonitis episodes from June 2018 until October 2019 in our center. Patients were identified and data were collected from our electronic renal registry and patient’s records. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Six patients were identified during the study period. Most patients (66.6%) were on automated peritoneal dialysis and the median duration of peritoneal dialysis before the episode of taurolidine was started was 43.66 ± 29.64 months. Mean taurolidine doses were 10 (range: 9–11) and 83.3% (five patients, with peritonitis caused by Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, and Corynebacterium propinquum) had a favorable response and microbial eradication without relapses after taurolidine treatment. Only one patient relapsed by the same organism ( Corynebacterium amycolatum) due to non-adherence to the antibiotic treatment prescribed. None of the patients experienced any relevant adverse events, with only two out of six presenting mild transient abdominal discomfort. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> We believe that peritoneal catheter taurolidine lock could be considered in cases of relapsing or refractory peritonitis, as it could prevent catheter removal and permanent switch to hemodialysis in selected cases, although literature is scarce and further studies are needed. </jats:p></jats:sec>

Relapsing and refractory peritoneal dialysis peritonitis caused by Corynebacterium amycolatum

“…The treatment protocol consisted of IP vancomycin and an aminoglycoside for 14–21 days. One of six enrolled patients had multiple episodes of C. amycolatum peritonitis, but further clinical details are missing [ 7 ]. Ubaldi et al assessed the frequency of Corynebacterium isolates in a medical microbiology laboratory over a 3-year period [ 11 ].…”

“…To date, only three cases of PD peritonitis due to C. amycolatum have been reported, all in adults [ 5 – 7 ]. Here, we present two children with several episodes of C. amycolatum peritonitis highlighting therapeutic challenges and the growing importance of this organism.…”

Exploring the potential of taurolidine in inducing mobilization and detachment of colon cancer cells: a preliminary in-vitro study

“…In clinical applications, taurolidine has been mostly used due to its antibacterial qualities. These applications include peritoneal lavage in children or in patients receiving peritoneal dialyses and display signs of peritonitis [ 15 , 16 ]. In some cases, taurolidine is also used to block central venous catheters [ 17 – 19 ].…”

EDTA and Taurolidine Affect Pseudomonas aeruginosa Virulence In Vitro —Impairment of Secretory Profile and Biofilm Production onto Peritoneal Dialysis Catheters

“…Taurolidine and calcium disodium EDTA are the most frequently prescribed antimicrobial lock solutions due to broad-spectrum activity and lack of bacterial resistance compared to standard antibiotic solutions. Promising anecdotal evidence provides clues on the successful treatment of relapsing peritonitis with taurolidine catheter-locking solution in peritoneal dialysis patients ( 16 – 18 ). Taurolidine has been effective in achieving the eradication of P. aeruginosa in PD patients with relapsing peritonitis ( 17 , 18 ).…”

“…Promising anecdotal evidence provides clues on the successful treatment of relapsing peritonitis with taurolidine catheter-locking solution in peritoneal dialysis patients ( 16 – 18 ). Taurolidine has been effective in achieving the eradication of P. aeruginosa in PD patients with relapsing peritonitis ( 17 , 18 ). There is limited experience with the use of the metal chelator EDTA as a lock solution in PD dialysis, but in vitro studies report an effective antibacterial effect of EDTA when used alone or in combination with classic antibiotics in models of P. aeruginosa infections ( 19 – 21 ) and P. aeruginosa biofilm-associated infections ( 22 – 24 ).…”