Taurolidine Lock vs Heparin Lock in Children and Adolescents on Chronic Parenteral Nutrition

Abstract

Introdution: Patients with intestinal failure (IF) requiring central venous catheters (CVCs) are at risk for frequent catheter-related bloodstream infections (CRBSIs).[1] Taurolidine is a catheter lock solution used for CRBSI prevention, however only few studies showed efficacy in pediatric patients. This study aimed to compare the use of taurolidine lock versus heparin lock to prevent CRBSI and catheter replacement in pediatric IF patients with chronic parenteral nutrition dependence. Methods: During a study period of 52 months, 28 patients (22 male, 6 female, median age 30 months (range 1-165 months) were enrolled. Inclusion criteria were: a) patients from 2 months through 8 years old; b) who had intestinal failure on PN by tunelled CVC for at least 8 weeks; c) on cyclic PN for at least 2 hours. The exclusion criteria were acquired or primary immunodeficiency or associated diseases requiring recurrent use of antibiotics such as cystic fibrosis. All patients were randomly assigned to one of 2 groups: taurolidine lock + citrate 4% (group A) and control with heparin lock 50 UI/ml (group B) and patients were observed for CRBSIs. Blood cultures were collected at the same time from peripheral and from CVC whenever infection was suspected. The main endpoint was the number of CRBSI/1,000 catheter days and also the number of catheter replacement/patient. Statistical analysis employed Student's t test and X2 for categorical variables. Trial registration ClinicalTrials.gov NCT02515201. Results: The total number of catheter days was 8,260 days, with the following number of days per group: group A=4,371 days; group B=3,889 days. CRBSI infection rate during the hospitalization period was 7.1/1000 on taurolidine and 7.9/1000 on heparin, with no significant difference among them. CRBSI infection rate during home PN period was 0.9/1000 on taurolidine and 2.6/1000 on heparin, with no significant difference among them. The number of catheter replacement during the hospitalization period was 27 on taurolidine and 32 on heparin, with no significant difference among them. Number of catheter replacement on home PN period was 6 on taurolidine and 5 on heparin, with no significant difference among them. Conclusion: In conclusion, our study showed that there was no difference between the incidence of CRBSI in pediatric home PN patients when comparing with heparin lock solution. Reference: 1. Chu HP, Brind J, Tomar R, Hill S. Significant reduction in central venous catheter-related bloodstream infections in children on HPN after starting treatment with taurolidine line lock. J Pediatr Gastroenterol Nutr. 2012;55(4):403–7.