Abstract
Catheter-related bloodstream infection (CRBSI) is one of the most common and potentially fatal complications in patients receiving home parenteral nutrition (HPN). In order to prevent permanent venous access loss, catheter locking with an antimicrobial solution has received significant interest and is often a favored approach as part of the treatment of CRBSI, but mainly for its prevention. Several agents have been used for treating and preventing CRBSI, for instance antibiotics, antiseptics (ethanol, taurolidine) and, historically, anticoagulants such as heparin. Nonetheless, current guidelines do not provide clear guidance on the use of catheter locks. Therefore, this review aims to provide a better understanding of the current use of antimicrobial locking in patients on HPN as well as reviewing the available data on novel compounds. Despite the fact that our current knowledge on catheter locking is still hampered by several gaps, taurolidine and ethanol solutions seem promising for prevention and potentially, but not proven, treatment of CRBSI. Additional studies are warranted to further characterize the efficacy and safety of these agents.
Highlights
Chronic intestinal failure (CIF) is defined as “the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth” [1]
Repeated Catheter-related bloodstream infection (CRBSI) may lead to failed venous access, which is an indication for intestinal transplantation [1,3]
Another in vitro study evaluating the effectiveness of a 3 day treatment with heparinized 40% ethanol lock solution showed a decrease in metabolic activity and biomass of biofilms in clinical isolates from patients with CRBSI
Summary
Chronic intestinal failure (CIF) is defined as “the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth” [1]. Besides adequate patient and caregiver training to handle the venous access device, additional preventive measures and, if necessary, treating CRBSI is of key importance in the management of patients with CIF. Central venous catheter-related infections are mostly managed based on protocols that are in accordance with the Infectious Diseases Society of America (IDSA) guidelines by Mermel et al [4]. The European Society for Clinical Nutrition and Metabolic Care (ESPEN) has more recently generated several recommendations for the care of adult patients with CIF, including the management of CVC [1]. The purpose of this review, is to provide an overview of current practices and research on the use of antimicrobial catheter locks as preventive and curative measures in adult patients with. CIF and to identify current gaps in our knowledge that require future research
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