Use of Catheter Lock Solutions in Patients Receiving Home Parenteral Nutrition: A Systematic Review and Individual‐Patient Data Meta‐Analysis

Abstract

Background Use of catheter lock solutions (CLSs) as a strategy to prevent catheter‐related bloodstream infections (CRBSIs) has been evaluated in recent clinical trials. Our aim was to identify the most effective CLS formulation in patients receiving home parenteral nutrition (HPN). Methods We conducted a systematic review and individual‐patient data meta‐analysis (IPDMA). Prospective randomized clinical trials in adult HPN patients using CLS were identified from PubMed, EMBASE, Web of Science, CINAHL, Cochrane library, and ClinicalTrials.gov. Primary outcome was the number of CRBSIs per 1000 catheter days for each CLS. Other outcomes included time to CRBSI and identification of patients with a higher risk for CRBSIs. Results In total, 1107 studies were screened for eligibility, of which three studies comprising 162 HPN patients and 45,695 catheter days were included in the IPDMA. CRBSI rates were significantly decreased in patients using taurolidine (rate 0.13; 95% confidence interval [CI], 0.05–0.32) when compared with saline (rate 0.74; 95% CI, 0.31–1.74; P = .002) or heparin (rate 2.01; 95% CI, 1.03–3.91; P < .001). The cumulative proportion of CRBSI‐free patients using taurolidine, saline, and heparin after 1 year was 88%, 56%, and 14%, respectively. Three risk factors for CRBSIs were identified: type of CLS, intestinal dysmotility as underlying condition, and use of central venous catheters. Conclusions Taurolidine was the most effective CLS formulation in HPN patients for the prevention of CRBSIs. We suggest discussing with patients the benefits and risks when starting taurolidine, especially in patients who are considered to have a higher risk for CRBSIs.

Short‐Bowel Syndrome: Epidemiology, Hospitalization Trends, In‐Hospital Mortality, and Healthcare Utilization

“…70,88,89 As a result of heightened awareness and continuous efforts for infection prevention, rates of CLABSI have significantly improved. 70,84,[90][91][92] Our study confirms that sepsis is the most important modifiable risk factor to prevent in-hospital mortality in patients with SBS, and therefore, home PN programs should continue their efforts to maintain the lowest possible infection rates. 93,94 Liver disease is also a common complication in patients with IF.…”

Considerations for the management of home parenteral nutrition during the SARS-CoV-2 pandemic: A position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN

“…Given the potential restrictions that may impact home care nursing support, as well as the need to reduce patient contact, IF teams should encourage patients and family members to train to self-administer PN, wherever possible. This may involve rapid training regimens if safe and feasible, with the risk of infection potentially reduced by the concomitant use of antimicrobial locks [12]. Alternatively, if training is not feasible, patients may need to consider the possibility of 24-h PN connection to reduce patient exposure from nursing visits, which may become a limited resource if home care nursing services are increasingly stretched during the pandemic.…”

The efficacy of taurolidine containing lock solutions for the prevention of central-venous-catheter-related bloodstream infections: a systematic review and meta-analysis

“…[9] Previous metaanalyses have been performed on this topic. [15][16][17][18][19][20] However, the majority of these meta-analyses did not include studies performed in all different patient groups. The most recent systematic review and meta-analysis including randomized controlled trials (RCT) investigating the efficacy of TLs in all patient populations was published in 2014.…”