A Randomized Double-Blind Controlled Trial of Taurolidine-Citrate Catheter Locks for the Prevention of Bacteremia in Patients Treated With Hemodialysis

作者：Solomon Laurie R^*; Chee**rough John S; Ebah Leonard; Al Sayed Tamer; Heap Michael; Millband Nick; Waterhouse Dee; Mitra Sandip; Curry Alan; Saxena Rema; Bhat Rammohan; Schulz Michael; Diggle Peter

来源：American Journal of Kidney Diseases, 2010, 55(6): 1060-1068.

DOI：10.1053/j.ajkd.2009.11.025

• Bacteremia
• catheter
• hemodialysis
• lock solution
• randomized trial
• taurolidine

Background: Bacteremia is a major cause of morbidity in patients using intravascular catheters. Interdialytic locking with antibiotics decreases the incidence of bacteremia, but risks antibiotic resistance. Taurolidine is a nontoxic broad-spectrum antimicrobial agent that has not been associated with resistance. Preliminary evidence suggests that taurolidine-citrate locks decrease bacteremia, but cause flow problems in established catheters.
Study Design: Double-blind randomized controlled trial.
Intervention: Interdialytic locking with taurolidine and citrate (1.35% taurolidine and 4% citrate) compared with heparin (5,000 U/mL) started at catheter insertion.
Setting & Participants: 110 adult hemodialysis patients with tunneled cuffed intravascular catheters inserted at 3 centers in Northwest England.
Outcomes & Measurements: Primary end points were time to first bacteremia episode from any cause and time to first use of thrombolytic therapy.
Results: There were 11 bacteremic episodes in the taurolidine-citrate group and 23 in the heparin group (1.4 and 2.4 episodes/1,000 patient-days, respectively; P = 0.1). There was no significant benefit of taurolidine-citrate versus heparin for time to first bacteremia (hazard ratio, 0.66; 95% CI, 0.2-1.6: P = 0.4). Taurolidine-citrate was associated with fewer infections caused by Gram-negative organisms than heparin (0.2 vs 1.1 infections/1,000 patient-days; P = 0.02); however, there was no difference for Gram-positive organisms (1.1 vs 1.2 infections/1,000 patient-days; P = 0.8). There was a greater need for thrombolytic therapy in the taurolidine-citrate versus heparin group (hazard ratio, 2.5; 95% CI, 1.3-5.2; P = 0.008).
Limitations: Small sample size. The study included bacteremia from all causes and was not specific for catheter-related bacteremia.
Conclusions: Taurolidine-citrate use did not decrease all-cause bacteremia and was associated with a greater need for thrombolytic treatment. There was a decrease in infections caused by Gram-negative organisms and a trend to a lower frequency of bacteremia, which warrants further study. Am J Kidney Dis 55: 1060-1068.

• 出版日期2010-6