P4.39: Citrate-taurolidine lock solution: impact on the incidence of catheter related bloodstream infections in children with intestinal failure receiving home parenteral nutrition

Abstract

Introduction: The use of central venous catheters (CVC) for parenteral nutrition (PN) administration has increased survival rates and allowed patients with short bowel syndrome who are dependent on long-term PN to be discharged for home care. However, catheter related bloodstream infection (CRBSI) remains as a major complication of long-term PN and is associated to increased morbidity, mortality, length of stay and hospital costs. Several lock solutions have been used to prevent CVC contamination. Among them, the citrate-taurolidine solution (composed of 2% taurolidine and 4% citrate), which is unique by reducing the biofilm formation of bacterial cells and avoiding bacterial adhesion and clotting in the catheter. We aimed to identify the rates of CRBSI before and after the use of the citrate-taurolidine solution in de-hospitalized children receiving home PN. Methods: This was a prospective cohort study in 11 children with intestinal failure (IF), mean age 35.4 months (12.7), receiving home PN and followed-up at a center for intestinal rehabilitation between July 2015 and November 2018. The rate of CRBSI was calculated for each patient by the incidence density ratio, defined as number of infections per 1,000 catheter-days. The citrate-taurolidine solution began to be used from March 2017 onward. The primary outcome was the variation in the rate of CRBSI before and after use of citrate-taurolidine lock solution. Results: The median time on PN was 26.4 months (interquartile range 15.2 - 32.9). The mean number of catheter days per patient before and after taurolidine were 178 (interquartile range 32 - 85.5) and 238 (interquartile range 203 - 386) days, respectively. There were 13 episodes of CRBSI before and only one episode after the use of citrate-taurolidine line locks. The incidence density of pre-taurolidine CRBSI was 5.7 and of post-taurolidine was 0.3 per 1000 catheter days. The main microorganism identified was Staphylococcus epidermidis. Conclusion: The rate of CRBSI was greatly reduced after the citrate-taurolidine use; this lock solution should be the first choice in reducing CRBSI in children with IF receiving home PN.