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A 2% taurolidine catheter lock solution prevents catheter-related bloodstream infection (CRBSI) and catheter dysfunction in hemodialysis patients

22 July 2021
12 min read
Volume 30 · Issue 14

Abstract

HIGHLIGHTS

2% taurolidine catheter lock solution without additives is safe and efficient.

CRBSI and dysfunction rates compare favorably against other studies in hemodialysis

Background:

In hemodialysis patients, catheter-related bloodstream infection (CRBSI) and catheter dysfunction are common and cause significant morbidity, mortality, and costs. Catheter lock solutions reduce CRBSI and catheter dysfunction rates, but solutions containing heparin, citrate, or antibiotics are associated with adverse effects. Due to its antimicrobial and antithrombotic properties and benign safety profile, taurolidine is suitable for use in catheter lock solutions. In this study the effectiveness and safety of a catheter lock solution containing 2% taurolidine without citrate or heparin (TauroSept®, Geistlich Pharma AG, Wolhusen, Switzerland) in hemodialysis patients were investigated for the first time.

Methods:

Data from 21 patients receiving chronic hemodialysis via tunneled central venous catheters with 2% taurolidine solution as a catheter lock were analyzed in a single-center retrospective study and compared with the existing literature in a review. The primary endpoint was CRBSI rate. Secondary endpoints included catheter dysfunction, treatment, and costs; catheter technical problems, resolution, and costs; and adverse events. Data were compared to outcomes with standard lock solutions in the literature.

Results:

No CRBSIs occurred during the observation period of 5,639 catheter days. The catheter dysfunction rate was 0.71 per 1,000 catheter days, and the catheter dysfunction treatment costs were CHF (Swiss Franc) 543 per patient. No technical problems or adverse events related to the use of 2% taurolidine-containing catheter lock solution were observed. These results compare favorably with other catheter lock solutions.

Conclusions:

A solution containing 2% taurolidine seems suitable as a hemodialysis catheter lock. In a Swiss cohort, it prevented CRBSI, limited catheter dysfunction, and was cost-efficient.

Tunneled catheters are frequently used for vascular access in hemodialysis patients despite all efforts to promote timely creation of arteriovenous fistulas.1,2 In fact, about 20% to 40% of chronic hemodialysis patients require tunneled central venous catheters during their dialysis dependency.3 However, central venous catheters carry a risk of catheter-related bloodstream infections (CRBSI). These can affect the patients seriously. Catheter-related bloodstream infections and catheter dysfunction are known to cause morbidity, cause mortality, and increase health care cost in hemodialysis patients.1,2 These patients are particularly vulnerable to infections due to their immune-compromised status, blood exposure during hemodialysis treatments and the extracorporeal circuit, contact with other patients and health care workers, and frequent hospitalization and surgery.4 In fact, catheter infection is a leading cause of death in patients with end-stage renal disease,5 and the main cause of catheter removal and morbidity in dialysis patients.6 In addition, catheter malfunction necessitates interventions such as instillation of thrombolytic agents, fibrin sheath stripping, and finally replacement of catheters if adequate blood flow cannot be attained. The result is low dialysis quality, which can be life-threatening.1

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