Abstract
Aims: Catheter-related infection, which is one of the major side effects of the use of dialysis catheters, leads to increases in hospitalization, morbidity and mortality. Antibiotic lock is an option for reducing the incidence of these infections, but there are concerns regarding antibiotic resistance. A prior study demonstrated that Taurolock (a taurolidine lock) may reduce the rate of catheter-related infection. Methods and Material: This investigation was a prospective before-and-after study. During period one, patients continued to use a heparin lock (5000 units/ml) for 6 months. During period two, they were shifted to Taurolock (a solution of 1.35% taurolidine, 4% citrate, and 500 units/ml of heparin) for 6 months. The primary outcome was the incidence of tunneled catheter-related infection and/or catheter exchange, and the secondary outcomes were the effects of Taurolock on catheter flow rate, dialysis adequacy, and catheter malfunction rate. Results: A total of 49 patients were included in this study. During period one, the primary outcome occurred 17 times, with an incidence rate of 86.8 per 100 patient-years; during period two, the primary outcome occurred 7 times, with an incidence rate of 32.6 per 100 patient-years (incidence rate ratio: 2.65, 95% confidence interval (CI): 1.05 - 7.6, P = 0.023). There was no significant difference between the two periods with respect to mean catheter blood flow rate (P = 0.29). During period one, thrombolytic therapy (TPA) lock was indicated on 19 occasions, with an incidence rate of 97 per 100 patient-years; during period two, TPA lock was indicated on 53 occasions, with an incidence rate of 247.5 per 100 patient-years (incidence rate ratio: 0.3, 95% CI: 0.21 - 0.67, P = 0.0003). Conclusions: We demonstrated that Taurolock usage is safe and effective for the prevention of dialysis catheter-related infection and/or catheter exchange.
Highlights
Hemodialysis (HD), which is the most common type of renal replacement therapy, requires vascular access to be obtained [1]-[3].Central venous catheters are used to provide blood access for HD patients, these catheters are generally only reluctantly employed due to safety concerns and associated frequent complications
Antibiotic lock has been proposed as a method for preventing catheter-related infection, the main concern associated with this treatment is the development of antibiotic resistance in dialysis patients
We examined the use of a taurolidine lock solution (Taurolock) in patients with tunneled catheters; in particular, the rates of catheter-related infection and/or required catheter exchange were compared before and after the introduction of this lock solution among patients treated in our unit at Hamad Medical Corporation (HMC), Doha, Qatar
Summary
Central venous catheters are used to provide blood access for HD patients, these catheters are generally only reluctantly employed due to safety concerns and associated frequent complications (mainly line infection). The risk of catheter-related bacteremia is proportional to the duration of central venous catheter use; in particular, this type of bacteremia occurs in 35% of patients within 3 months and 48% of patients within 6 months and exhibits an incidence rate of 0.9 to 2.0 episodes per catheter-year [4]-[7]. Antibiotic lock has been proposed as a method for preventing catheter-related infection, the main concern associated with this treatment is the development of antibiotic resistance in dialysis patients. Small studies have indicated that taurolidine reduces the rate of catheter-related infection with no side effects [8]-[10]
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