American Journal of Kidney Diseases
Volume 55, Issue 6 , Pages 1060-1068 , June 2010

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

  • Laurie R. Solomon, FRCP

      Affiliations

    • Renal Unit, Lancashire Teaching Hospitals, Royal Preston Hospital, Lancashire, UK
    • Corresponding Author InformationAddress correspondence to Laurie R. Solomon, FRCP, Renal Unit, Lancashire Teaching Hospitals, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, Lancashire PR2 9HT, UK
    • ,
  • John S. Cheesbrough, FRCPath

      Affiliations

    • Department of Microbiology, Lancashire Teaching Hospitals, Royal Preston Hospital, Lancashire, UK
    • ,
  • Leonard Ebah, MRCP

      Affiliations

    • Renal Unit, Lancashire Teaching Hospitals, Royal Preston Hospital, Lancashire, UK
    • ,
  • Tamer Al-Sayed, MRCP

      Affiliations

    • Renal Unit, Lancashire Teaching Hospitals, Royal Preston Hospital, Lancashire, UK
    • ,
  • Michael Heap, RGN

      Affiliations

    • Renal Unit, Lancashire Teaching Hospitals, Royal Preston Hospital, Lancashire, UK
    • ,
  • Nick Millband, MBCS

      Affiliations

    • Renal Unit, Lancashire Teaching Hospitals, Royal Preston Hospital, Lancashire, UK
    • ,
  • Dee Waterhouse, RGN

      Affiliations

    • Renal Unit, Manchester Royal Infirmary, Manchester, UK
    • ,
  • Sandip Mitra, FRCP

      Affiliations

    • Renal Unit, Manchester Royal Infirmary, Manchester, UK
    • ,
  • Alan Curry, PhD

      Affiliations

    • Health Protection Agency, Manchester Royal Infirmary, Manchester, UK
    • ,
  • Rema Saxena, MRCP

      Affiliations

    • Renal Unit, Royal Liverpool Hospitals, Liverpool, UK
    • ,
  • Rammohan Bhat, MRCP

      Affiliations

    • Renal Unit, Royal Liverpool Hospitals, Liverpool, UK
    • ,
  • Michael Schulz, FRCP

      Affiliations

    • Renal Unit, Royal Liverpool Hospitals, Liverpool, UK
    • ,
  • Peter Diggle, PhD

      Affiliations

    • CHICAS, Division of Medicine, School of Health and Medicine, University of Lancaster, Lancaster, UK

Received 23 May 2009 ,Accepted 27 November 2009.

References 

  1. Centers for Disease Control and Prevention. Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients—United States, 2005. MMWR Morbid Mortal Wkly Rep. 2007;56(9):197–199
  2. McIntyre CW, Hulme LJ, Taal M, Fluck RJ. Locking of tunnelled hemodialysis catheters with gentamicin and heparin. Kidney Int. 2004;66:801–805
  3. Dogra GK, Herson H, Hutchison B, et al. Prevention of tunnelled hemodialysis catheter-related infections using catheter-restricted filling with gentamicin and citrate: a randomised control study. J Am Soc Nephrol. 2002;13:2133–2139
  4. Saxena AK, Panhotra BR, Sundaram DS, Naguib M, Morsy F, Al-Arabi Al-Ghamdi AM. Enhancing the survival of tunnelled hemodialysis catheters using an antibiotic lock in the elderly: a randomised, double-blind clinical trial. Nephrology. 2006;11:299–305
  5. Nori US, Manoharan A, Yee J, Besarab A. Comparison of low-dose gentamicin with minocycline as catheter lock solutions in the prevention of catheter-related bacteremia. Am J Kidney Dis. 2006;48(4):596–605
  6. Labriola L, Crott R, Jadoul M. Preventing hemodialysis catheter-related bacteremia with an antimicrobial lock solution: a meta-analysis of prospective randomized trials. Nephrol Dial Transplant. 2008;23:1666–1672
  7. Sweet S, Gobeille S, Landry D, Haessler S, Vaidya C, Braden G. Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis [abstract 206]. Am J Kidney Dis. 2009;53(4):74A
  8. Dixon J, Steele M, Makanjuola D. Does the use of line locks lead to antibiotic resistant organisms as compared with systemic antibiotics alone in the treatment of hemodialysis catheter infections?. Abstract presented at Renal Association Meeting; April 21-24, 2009; Liverpool, UK http://www.renal.org/pages/media/Meetings/RA%202009%20ABSTRACT_BOOK.pdf2009;Accessed December 30
  9. Torres-Viera C, Thauvin-Eliopoulos C, Souli M, et al. Activities of taurolidine in vitro and in experimental enterococcal endocarditis. Antimicrob Agents Chemother. 2000;44(6):1720–1724
  10. Shah CB, Mittelam MW, Costerton JW, et al. Antimicrobial activity of a novel catheter lock solution. Antimicrob Agents Chemother. 2003;46(6):1674–1679
  11. Quarello F, Forneris G. Prevention of hemodialysis catheter-related bloodstream infection using an antimicrobial lock. Blood Purif. 2002;20:87–92
  12. Taylor C, Cahill J, Gerrish M, Little J. A new hemodialysis catheter-locking agent reduces infections in hemodialysis patients. J Ren Care. 2008;34(3):116–120
  13. Jurewitsch B, Jeejeebhoy KN. Taurolidine lock: the key to prevention of recurrent catheter-related bloodstream infections. Clin Nutr. 2005;24:462–465
  14. Simon A, Ammann RA, Wiszniewsky G, Bode U, Fleischhack G, Besuden MM. Taurolidine-citrate lock solution (Taurolock) significantly reduces CVAD-associated gram positive infections in pediatric cancer patients. BMC Infect Dis. 2008;8:102–109
  15. Koldehoff M, Zakrzewski JL. Taurolidine is effective in the treatment of central venous catheter-related bloodstream infections in cancer patients. Int J Antimicrob Agents. 2004;24(5):491–495
  16. Allon M. Prophylaxis against dialysis catheter-related bacteremia with a novel antimicrobial lock solution. Clin Infect Dis. 2003;36:1539–1544
  17. Betjes MGH, van Agteren M. Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution. Nephrol Dial Transplant. 2004;19:1546–1551
  18. Cheesbrough JS, Finch RG, Burden RP. A prospective study of the mechanisms of infection associated with hemodialysis catheters. J Infect Dis. 1986;154(4):579–589
  19. Johnson DW, MacGinley R, Kay TD, et al. A randomised controlled trial of topical exit-site mupirocin application in patients with tunnelled cuffed haemodialysis catheters. Nephrol Dial Transplant. 2002;17:1802–1807
  20. Lok CE, Stanley KE, Hux JE, Richardson R, Tobe SW, Conly J. Hemodialysis infection prevention with polysporin ointment. J Am Soc Nephrol. 2003;13:169–179
  21. Cheesbrough JS, Elliot TJS, Finch RG. A morphological study of bacterial colonisation of intravenous cannulae. J Med Microbiol. 1985;19:149–157
  22. Weijmer MC, Debets-Ossenkopp YJ, van de Vondervoort FJ, et al. Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. J Am Soc Nephrol. 2005;16:2769–2777
  23. Department of Health. Saving Lives: Reducing Infection, Delivering Clean and Safe Care, High Impact Intervention Nos. 2c and 3, Renal Dialysis Catheter Care Bundle. UK: Crown Publications; Oct, 2007;www.clean-safe-care.nhs.uk/toolfiles/19_SL_HII_3_v2.pdf
  24. Willatts SM, Radford S, Leitermann M. Effect of the anti-endotoxic agent, taurolidine, in the treatment of sepsis syndrome, a placebo controlled double-blind controlled trial. Crit Care Med. 1995;23(6):1033–1039
  25. Johnston DA, Phillips G, Perry M, McAlpine H, Richards J, Pennington CR. Taurolin for the prevention of parenteral nutrition related infection: antimicrobial activity and long-term use. Clin Nutr. 1993;12:365–368
  26. Power A, Duncan N, Singh SK, et al. Sodium citrate versus heparin catheter locks for cuffed central venous catheters: a single center randomised control trial of sodium citrate versus heparin line locks for cuffed central venous catheters. Am J Kidney Dis. 2009;53(6):1034–1041
  27. US Food and Drug Administration. FDA Issues Warning on Tricitrasol Dialysis Catheter Anticoagulant (FDA Talk Paper TOO-16 14). April 14, 2000;
  28. Ash SR, Mankus RA, Sutton JM. Concentrated sodium citrate (23%) for catheter lock. Haemdial Int. 2000;4:22–31
  29. Stas KJF, Vanwalleghem J, de Moor B, Keulers H. Trisodium citrate 30% vs heparin 5% as catheter lock in the interdialytic period in twin- or double-lumen dialysis catheters for intermittent hemodialysis. Nephrol Dial Transplant. 2001;16:1521–1522

 Originally published online as doi:10.1053/j.ajkd.2009.11.025 on March 8, 2010.

 Trial registration: www.isrctn.org; study number: ISRCTN51902376.

PII: S0272-6386(09)01668-0

doi: 10.1053/j.ajkd.2009.11.025

American Journal of Kidney Diseases
Volume 55, Issue 6 , Pages 1060-1068 , June 2010

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