Abstract
Infection is one of the most commonly described complications, and a major cause of morbidity and mortality in pediatric patients treated using central venous catheters (CVCs). Taurolidine lock solutions have been used to decrease catheter-related bloodstream infections (CRBSIs) in both adult and pediatric patients. The purpose of this study was to systematically search the literature and conduct a meta-analysis to determine the efficacy of taurolidine in reducing CRBSI in children. We conducted an electronic search of the PubMed, EMBASE, Cochrane Library, TRIP Database, CINAHL, and Google Scholar databases for articles published up to 1st November 2019. Eligible studies included randomized controlled trials (RCTs) comparing the effects of taurolidine with control for preventing CRBSI in pediatric patients. Four studies were included. Our results indicated a statistical significant reduction in the total number of CRBSI with taurolidine as compared to control (RR: 0.23; 95% CI:0.13, 0.40; I2 = 0%; P<0.00001). The pooled analysis also indicated a statistical significant reduction in the incidence of CRBSI (defined as the number of CRBSI events/1000 catheter days) in the taurolidine group (MD: -1.12; 95% CI:-1.54, -0.71; I2 = 1%; P<0.00001). The number of catheters removed due to infection or suspected infection was not significantly different between the two groups (RR: 0.68; 95% CI:0.22, 2.10; I2 = 56%; P = 0.50) (Fig 5). The quality of the included studies was not high. The use of taurolidine as a catheter locking solution may significantly reduce CRBSI in pediatric patients. However, the quality of current evidence is not high and further high-quality large scale RCTs are needed to corroborate our results.
Highlights
Central venous catheters (CVCs) are often an inevitable part of treating adult and pediatric patients receiving antibiotic therapy, parenteral nutrition, hemodialysis, chemotherapy, or hospitalized in Intensive Care Units. (ICU) [1]
Our results indicated a statistical significant reduction in the total number of catheter-related bloodstream infections (CRBSI) with taurolidine as compared to control (RR: 0.23; 95% confidence interval (CI):0.13, 0.40; I2 = 0%; P
The long-term use of CVCs carries a risk of catheter-related bloodstream infections (CRBSI) that are associated with increased morbidity and mortality rates
Summary
Central venous catheters (CVCs) are often an inevitable part of treating adult and pediatric patients receiving antibiotic therapy, parenteral nutrition, hemodialysis, chemotherapy, or hospitalized in Intensive Care Units. (ICU) [1]. The long-term use of CVCs carries a risk of catheter-related bloodstream infections (CRBSI) that are associated with increased morbidity and mortality rates. According to the Centre for Disease Control and Prevention, an estimated 41,000 new cases of CRBSI are diagnosed annually and the disease has a mortality. Taurolidine for catheter related infections rate of 12–15% in the general population [2]. Prevention of CRBSI is pivotal to improve clinical outcomes in high-risk patients. Intraluminal contamination, especially with Staphylococci, is considered the main cause for CRBSI, and the risk of infection further increases with long-term catheter use [3]. CRBSI rates are high in pediatric patients (over 10 per 1000 catheter-days) and are associated with increased mortality and treatment costs [4,5]
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