A Randomized Double-Blind Controlled Trial of Taurolidine-Citrate Catheter Locks for the Prevention of Bacteremia in Patients Treated With Hemodialysis

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1060-1068
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume55
Issue number6
DOIs
StatePublished - Jun 2010
Externally publishedYes

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Bacteremia
Citric Acid
Renal Dialysis
Catheters
Heparin
Thrombolytic Therapy
Infection
taurolidine
Microbial Drug Resistance
Anti-Infective Agents
Double-Blind Method
England
Sample Size
Randomized Controlled Trials
Anti-Bacterial Agents
Morbidity
Incidence

Keywords

  • Bacteremia
  • catheter
  • hemodialysis
  • lock solution
  • randomized trial
  • taurolidine

ASJC Scopus subject areas

  • Nephrology

Cite this

A Randomized Double-Blind Controlled Trial of Taurolidine-Citrate Catheter Locks for the Prevention of Bacteremia in Patients Treated With Hemodialysis. / Solomon, Laurie R.; Cheesbrough, John S.; Ebah, Leonard; Al-Sayed, Tamer; Heap, Michael; Millband, Nick; Waterhouse, Dee; Mitra, Sandip; Curry, Alan; Saxena, Rema; Bhat, Rammohan; Schulz, Michael; Diggle, Peter.

In: American Journal of Kidney Diseases, Vol. 55, No. 6, 06.2010, p. 1060-1068.

Research output: Contribution to journalArticle

Solomon, LR, Cheesbrough, JS, Ebah, L, Al-Sayed, T, Heap, M, Millband, N, Waterhouse, D, Mitra, S, Curry, A, Saxena, R, Bhat, R, Schulz, M & Diggle, P 2010, 'A Randomized Double-Blind Controlled Trial of Taurolidine-Citrate Catheter Locks for the Prevention of Bacteremia in Patients Treated With Hemodialysis', American Journal of Kidney Diseases, vol. 55, no. 6, pp. 1060-1068. https://doi.org/10.1053/j.ajkd.2009.11.025
Solomon, Laurie R. ; Cheesbrough, John S. ; Ebah, Leonard ; Al-Sayed, Tamer ; Heap, Michael ; Millband, Nick ; Waterhouse, Dee ; Mitra, Sandip ; Curry, Alan ; Saxena, Rema ; Bhat, Rammohan ; Schulz, Michael ; Diggle, Peter. / A Randomized Double-Blind Controlled Trial of Taurolidine-Citrate Catheter Locks for the Prevention of Bacteremia in Patients Treated With Hemodialysis. In: American Journal of Kidney Diseases. 2010 ; Vol. 55, No. 6. pp. 1060-1068.
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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.",
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AU - Cheesbrough, John S.

AU - Ebah, Leonard

AU - Al-Sayed, Tamer

AU - Heap, Michael

AU - Millband, Nick

AU - Waterhouse, Dee

AU - Mitra, Sandip

AU - Curry, Alan

AU - Saxena, Rema

AU - Bhat, Rammohan

AU - Schulz, Michael

AU - Diggle, Peter

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N2 - 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.

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