Taurolidine–citrate lock solution for the prevention of central line‐associated bloodstream infection in paediatric haematology–oncology and gastrointestinal failure patients with high baseline central‐line associated bloodstream infection rates

Abstract

Aim: Central line-associated bloodstream infection associated bloodstream infection (CLABSI) is a serious complication of patients on central venous catheters (CVC). Taurolidine-citrate solution (TCS) is a catheter-lock solution with broad-spectrum antimicrobial action. This study's aim was to evaluate the efficacy of TCS in reducing CLABSI rates in paediatric haematology-oncology (H/O) and gastrointestinal (GI) patients with long-term CVC. Methods:This was an open-label trial of H/O and GI inpatients with the following inclusion criteria: <17 years old, more than or equal to one previous CLABSI and a minimum TCS dwell time of ≥8 h. CLABSI per 1000 catheter-days was calculated from each patient's first CVC insertion till 14 December 2017 or until TCS discontinuation. Results: Thirty-three patients were recruited with a median age of 3.5 years; H/O and GI constituted 60.6 and 39.4% respectively. CVC types were Hickman line (45.5%), implantable port (24.2%) and peripherally inserted central catheter (30.3%). Mean pre-and post-TCS CLABSI rates per 1000 catheter-days were 14.44 and 2.45 (P < 0.001) for all patients; 16.55 and 2.81 for H/O patients; and 11.21 and 1.90 for GI patients, respectively. Pre-and post-TCS rate ratio was 0.20, 0.10 and 0.30 for all, H/O and GI patients, respectively (P < 0.001). TCS also led to a reduction in CVC removal from 66.7 to 9.09% (P < 0.001). Conclusions: TCS usage was highly successful in CLABSI reduction by 80% in all patients, 90% in H/O and 70% in GI patients. In patients with high baseline CLABSI rates, TCS is an effective catheter-lock therapy to reduce CLABSI rates in paediatric patients.

S-Nitroso-N-acetyl-l-cysteine Ethyl Ester (SNACET) Catheter Lock Solution to Reduce Catheter-Associated Infections

“…In this approach, a highly concentrated solution of antimicrobial agents (typically 100–1000 times higher than the planktonic MIC) is instilled within an intravascular catheter for up to 24–48 h while it is not in use to inhibit colonization or to eradicate bacteria on the inner lumen of the infected catheter. Various antibiotics, such as vancomycin, , daptomycin, gentamicin, minocycline, trimethoprim, , teicoplanin, and nonantibiotic solutions, such as citrate, ethanol, , tetrasodium ethylenediaminetetraacetic acid (EDTA), taurolidine, , nitroglycerin, sodium bicarbonate, have been reported as antimicrobial-lock solutions either alone or in combination for the prevention of CRBSIs. , However, persistent use of these antibiotic lock solutions may lead to the emergence of antibiotic resistance and thus limits the long-term prevention of CRBSIs. Further, antibiotic-based lock solutions only have the potential to eradicate microbes present on the inner luminal surfaces, are limited in their ability to penetrate established biofilms on surfaces, and cannot diffuse through the catheter wall to eradicate microbes that may contaminate the outer luminal surfaces ( e.g ., microbial contamination from skin). , Therefore, the development of a new class of nonantibiotic antimicrobial-lock solutions is a prerequisite to replace the antibiotic-based lock solutions in the near future.…”

“…13 In this approach, a highly concentrated solution of antimicrobial agents (typically 100− 1000 times higher than the planktonic MIC) is instilled within an intravascular catheter for up to 24−48 h while it is not in use to inhibit colonization or to eradicate bacteria on the inner lumen of the infected catheter. Various antibiotics, such as vancomycin, 14,15 daptomycin, 16 gentamicin, 17 minocycline, 18 trimethoprim, 9,19 teicoplanin, 20 and nonantibiotic solutions, such as citrate, 21 ethanol, 22,23 tetrasodium ethylenediaminetetraacetic acid (EDTA), 8 taurolidine, 21,24 nitroglycerin, 25 sodium bicarbonate, 26 have been reported as antimicrobiallock solutions either alone or in combination for the prevention of CRBSIs. 27,28 However, persistent use of these antibiotic lock solutions may lead to the emergence of antibiotic resistance and thus limits the long-term prevention of CRBSIs.…”

Postoperative Rather Than Preoperative Neutropenia Is Associated With Early Catheter-related Bloodstream Infections in Newly Diagnosed Pediatric Cancer Patients

“…Prophylactic use of granulocyte colony-stimulating factor in children receiving myelosuppressive chemotherapy may reduce the incidence of febrile neutropenia and duration of severe neutropenia and antibiotic use but has not been shown to conclusively reduce documented infections or infectionrelated mortality. 35,36 Use of adjuncts like antibiotic taurolidine locks and postoperative catheter care bundles have also been shown to decrease CRBSI rates 22,37,38 but have not been specifically studied in the apparent high-risk postoperative period. There is also a lack of predictive models to assess patients' risk of developing CRBSI during the course of treatment.…”

Infection Prevention and Management in Pediatric Short Bowel Syndrome

“…A recent open label study on taurolidine lock therapy included 33 pediatric CV line-dependent patients with at least one previously confirmed line infection. After a median duration of 140 days, taurolidine lock therapy showed 80% reduction in CRBSIs compared to pre-lock infections rates ( 19 ). Also, in a randomized controlled study on 41 adult patients with IF with significant history of previous CRBSIs, combined taurolidine-heparin locks were 100% efficacious in median 337 days in preventing CRBSIs when compared to heparin locks alone ( 20 ).…”