http://kidneyfunction.org Renal Information Sun, 22 Jan 2012 23:48:20 +0000 en hourly 1 http://wordpress.org/?v=3.0.2 http://kidneyfunction.org/a-randomized-double-blind-controlled-trial-of-taurolidine-citrate-catheter-locks-for-the-prevention-of-bacteremia-in-patients-treated-with-hemodialysis-corrected-proof/ http://kidneyfunction.org/a-randomized-double-blind-controlled-trial-of-taurolidine-citrate-catheter-locks-for-the-prevention-of-bacteremia-in-patients-treated-with-hemodialysis-corrected-proof/#comments Mon, 08 Mar 2010 13:00:00 +0000 Laurie R. Solomon, John S. Cheesbrough, Leonard Ebah, Tamer Al-Sayed, Michael Heap, Nick Millband, Dee Waterhouse, Sandip Mitra, Alan Curry, Rema Saxena, Rammohan Bhat, Michael Schulz, Peter Diggle http://10.1053/j.ajkd.2009.11.025 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.

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