A randomized double-blind controlled trial of taurolidine-citrate catheter locks for the prevention of bacteremia in patients treated with hemodialysis.

Abstract

BACKGROUND:

Bacteremia is a major cause of morbidity in patients using intravascular catheters. Interdialytic locking with antibiotics decreases the incidence of bacteremia, but risks antibiotic resistance. Taurolidine is a nontoxic broad-spectrum antimicrobial agent that has not been associated with resistance. Preliminary evidence suggests that taurolidine-citrate locks decrease bacteremia, but cause flow problems in established catheters.

STUDY DESIGN:

Double-blind randomized controlled trial.

INTERVENTION:

Interdialytic locking with taurolidine and citrate (1.35% taurolidine and 4% citrate) compared with heparin (5,000 U/mL) started at catheter insertion.

SETTING & PARTICIPANTS:

110 adult hemodialysis patients with tunneled cuffed intravascular catheters inserted at 3 centers in Northwest England.

OUTCOMES & MEASUREMENTS:

Primary end points were time to first bacteremia episode from any cause and time to first use of thrombolytic therapy.

RESULTS:

There were 11 bacteremic episodes in the taurolidine-citrate group and 23 in the heparin group (1.4 and 2.4 episodes/1,000 patient-days, respectively; P = 0.1). There was no significant benefit of taurolidine-citrate versus heparin for time to first bacteremia (hazard ratio, 0.66; 95% CI, 0.2-1.6: P = 0.4). Taurolidine-citrate was associated with fewer infections caused by Gram-negative organisms than heparin (0.2 vs 1.1 infections/1,000 patient-days; P = 0.02); however, there was no difference for Gram-positive organisms (1.1 vs 1.2 infections/1,000 patient-days; P = 0.8). There was a greater need for thrombolytic therapy in the taurolidine-citrate versus heparin group (hazard ratio, 2.5; 95% CI, 1.3-5.2; P = 0.008).

LIMITATIONS:

Small sample size. The study included bacteremia from all causes and was not specific for catheter-related bacteremia.

CONCLUSIONS:

Taurolidine-citrate use did not decrease all-cause bacteremia and was associated with a greater need for thrombolytic treatment. There was a decrease in infections caused by Gram-negative organisms and a trend to a lower frequency of bacteremia, which warrants further study.

• Authors: Laurie R Solomon, John S Cheesbrough, Leonard Ebah, Tamer Al-Sayed, Michael Heap, Nick Millband, Dee Waterhouse, Sandip Mitra, Alan Curry, Rema Saxena, Rammohan Bhat, Michael Schulz, Peter Diggle
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 55 Issue 6 Pg. 1060-8 (Jun 2010) ISSN: 1523-6838 [Electronic] United States
• PMID: 20207458 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-Infective Agents
• Anticoagulants
• Thiadiazines
• Taurine
• Citric Acid
• taurolidine
• Heparin

Topics

• Adult
• Aged
• Anti-Infective Agents (therapeutic use)
• Anticoagulants (therapeutic use)
• Bacteremia (epidemiology, etiology, prevention & control)
• Catheters, Indwelling (microbiology)
• Citric Acid (therapeutic use)
• Double-Blind Method
• Female
• Gram-Positive Bacterial Infections (epidemiology, etiology, prevention & control)
• Heparin (therapeutic use)
• Humans
• Incidence
• Kidney Failure, Chronic (therapy)
• Male
• Middle Aged
• Renal Dialysis (adverse effects, instrumentation, methods)
• Taurine (analogs & derivatives, therapeutic use)
• Thiadiazines (therapeutic use)