Antimicrobial activity of hemodialysis catheter lock solutions in relation to other compounds with antiseptic properties.

Elżbieta Piątkowska,Justyna Paleczny,Krzysztof Letachowicz,Karolina Dydak,Guadalupe Virginia Nevárez-Moorillón

doi:10.1371/journal.pone.0258148

Elżbieta Piątkowska, Justyna Paleczny + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0258148

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Journal: PloS one	Publication Date: Oct 7, 2021
Citations: 6	License type: CC BY 4.0

Affiliation: Wroclaw Medical University, University of Wrocław

Abstract

Proper protection of vascular access after haemodialysis is one of the key measures for the prevention of catheter-related infections. Various substances with bactericidal and anticoagulant properties are used to fill catheters, but due to the unsatisfactory clinical effects and occurrence of adverse reactions, the search for new substances is still ongoing. In the present paper, we compared the in vitro antimicrobial activity of solutions used for tunnelled catheter locking (taurolidine, trisodium citrate) and solutions of substances that could potentially be used for this purpose (sodium bicarbonate, polyhexanide-betaine). The studies have been conducted on bacteria that most commonly cause catheter-related infections. The values of both minimum inhibitory concentration and minimum biofilm eradication concentration of the substances were determined. The ability of the tested substances to eradicate biofilm from the dialysis catheter surface was also evaluated. The results showed that polyhexanide-betaine inhibited the growth of all microbes comparably to taurolidine, even after ≥ 32-fold dilution. The activity of trisodium citrate and sodium bicarbonate was significantly lower. Polyhexanide exhibited the highest activity in the eradication of bacterial biofilm on polystyrene plates. The biofilm formed on a polyurethane dialysis catheter was resistant to complete eradication by the test substances. Polyhexanide-betaine and taurolidine showed the highest activity. Inhibition of bacterial growth regardless of species was observed not only at the highest concentration of these compounds but also after dilution 32–128x (taurolidine) and 32–1024x (polyhexanide-betaine). Therefore, it can be assumed that taurolidine application as a locking solution prevents catheter colonization and systemic infection development. Taurolidine displays high antimicrobial efficacy against Gram-positive cocci as well as Gram-negative bacilli. On the contrary, the lowest antibacterial effect displayed product contained sodium bicarbonate. The inhibitions of bacterial growth were not satisfactory to consider it as a substance for colonization prevention. Polyhexanidine-betaine possessed potent inhibitory and biofilm eradication properties comparing to all tested products. PHMB is applied as a wound irrigation solution worldwide. However, based on our results, we assume that the PHMB is a promising substance for catheter locking solutions thanks to its safety and high antimicrobial properties.

Highlights

Central venous catheters (CVCs) are the fastest and most commonly used means of obtaining vascular access in patients requiring hemodialysis
The present study used the following reference strains from the American Type Culture Collection (ATCC) belonging to the Chair and Department of Pharmaceutical Microbiology and Parasitology at Wroclaw Medical University: Staphylococcus aureus ATCC 33591, Staphylococcus aureus ATCC 6538, Klebsiella pneumoniae ATCC 4352, Enterococcus faecium ATCC 19434, Enterobacter cloacae ATCC 13047 and 20 clinical strains isolated from blood and from dialysis catheters
Clinical isolates were obtained from the Academic Center for Laboratory Diagnostics (ACDL), which perform routine analysis for patients hospitalized in the University Hospital in Wroclaw at the departments of anesthesiology and intensive care, neurology, nephrology, general surgery, angiology, cardiology, geriatrics and internal and occupational diseases

Summary

Introduction

Central venous catheters (CVCs) are the fastest and most commonly used means of obtaining vascular access in patients requiring hemodialysis. Among late life-threatening complications are catheterrelated thrombosis (CRT), central vein stenosis and catheter-related bloodstream infections (CRBSI) [3,4]. The latter is a consequence of earlier colonization of the catheter or the site of its entry by microorganisms, and, like other complications, they lead to more frequent hospitalizations and an increase in patient mortality [5,6]. The lowest indicators are presented in the publication of Van Der Meersch et al, in which they did not exceed 0.24 per 1000 catheter days, regardless of the type of dialysis catheter used [12]

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