Taurolidine irrigation reduces relapse and recurrence of hemodialysis access infection

Abstract

ObjectivesInfection of hemodialysis access is a clinically important concern and can lead to increased morbidity and mortality among patients on hemodialysis. In this study, we aimed to determine whether using taurolidine as an irrigating antiseptic after drainage of pus or removal of infected tissue and graft during surgery decreases the relapse and recurrence of infection. MethodsBetween January 2016 and December 2023, 48 episodes in 38 patients hospitalized and treated for hemodialysis access infections were examined. Relapse, recurrence, and mortality of infection were analyzed in patients who received additional taurolidine irrigation versus those who did not. After drainage alone or after total or partial graft removal, all patients received massive irrigation with normal saline. The episodes of infection were examined consecutively during follow-up. ResultsThe majority (97.9%) of hemodialysis access infections were arteriovenous grafts (AVGs) or interposed grafts from native veins. In AVGs, infections occurred primarily after a median of 523 days from the first needling. All prosthetic materials that were the infection foci were removed in 58.3% of the cases, with partial resection and bypass or drainage performed in the remaining cases. The most common pathogen was Staphylococcus aureus (45.8%). After surgical intervention, relapse was observed in 12.5% of the cases and recurrence in 20.8% of the cases. The relapse occurrence was significantly reduced by taurolidine irrigation (odds ratio [OR]: 0.16, 95% confidence interval [CI]: 0.02–0.98, p = 0.05) and the total resection of prosthetic material (OR: 0.07, 95% CI: 0.01–0.70, p = 0.02). Recurrence was significantly decreased by taurolidine irrigation (OR: 0.10, 95% CI: 0.02–0.56, p = 0.01) and increased dramatically in cases with relapse history (OR: 8.50, 95% CI: 1.69–42.76, p < 0.01). Finally, male sex (hazard ratio: 7.01, 95% CI: 1.19–41.40, p = 0.03) and AVG (hazard ratio: 4.49, 95% CI: 1.01–20.01, p = 0.05) were significantly associated with increased overall mortality in infected hemodialysis access. ConclusionsAdditional taurolidine irrigation after surgical resection significantly reduced the relapse and recurrence of infection in hemodialysis access. Taurolidine appears to be a safe and useful antiseptic for the control of hemodialysis access infection.