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Azadbakht M, Razian A, Pooria A, Hadian B. Comparison of the effect of heparin, reteplase, and taurolock in the prevention of thrombosis in hemodialysis catheters. Health Sci Rep 2024; 7:e2057. [PMID: 38736476 PMCID: PMC11082089 DOI: 10.1002/hsr2.2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/13/2024] [Accepted: 03/31/2024] [Indexed: 05/14/2024] Open
Abstract
Background and Aim One of the complications of using catheters is the occurrence of thrombosis, which can be dangerous for patients. The main objective of this study is to compare the effect of heparin, reteplase, and taurolock in the prevention of thrombosis in hemodialysis catheters. Methods The present study is a clinical trial, in which the effect of three drugs, heparin, reteplase, and taurolock, in the prevention of thrombosis in hemodialysis catheters, has been investigated. The research units were studied in two intervention and control groups. The stratified random allocation method was used to assign patients to five groups (control, Heparin 50, Heparin 1000, reteplase, and taurolock), with strata based on the patient's age (20-70 years), gender, and duration of dialysis. Within each stratum, patients were also assigned to groups using the randomized block permutation method and a random number table tool. To prevent bias, this study is triple-blinded. This means that the patient, the thrombosis assessor, and the statistical analyst are unaware of the type of intervention received by the patient. Results Gender (p < 0.999), age distribution (p = 0.774), and duration of dialysis (p = 0.875) showed no statistically significant relationship with thrombosis. However, significant differences were observed among the five groups regarding thrombosis incidence. The relative risk of thrombosis in the Heparin 50, Heparin 1000, reteplase, and taurolock groups compared to the control group was 92.5%, 92.2%, 98.2%, and 89% lower, respectively. Conclusion Our study underscores the efficacy of heparin, reteplase, and taurolock in preventing thrombosis in hemodialysis catheters. While all three drugs demonstrated efficacy, the Heparin 50 group exhibited the highest relative risk reduction. These findings suggest that heparin, particularly at a low dose, should be considered a standard prophylactic treatment in hemodialysis patients.
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Affiliation(s)
- Morteza Azadbakht
- Department of Surgery, School of MedicineLorestan University of Medical SciencesKhorramabadIran
| | - Azadeh Razian
- Student of Research CommitteeLorestan University of Medical SciencesKhorramabadIran
| | - Ali Pooria
- Department of Cardiology, School of MedicineLorestan University of Medical SciencesKhorramabadIran
| | - Babak Hadian
- Department of Internal Medicine, School of MedicineLorestan University of Medical SciencesKhorramabadIran
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Haq A, Patel D, Gutlapalli SD, Hernandez GN, Seffah KD, Zaman MA, Awais N, Satnarine T, Ahmed A, Khan S. A Systematic Review of the Impact of Antibiotic and Antimicrobial Catheter Locks on Catheter-Related Infections in Adult Patients Receiving Hemodialysis. Cureus 2023; 15:e45000. [PMID: 37829985 PMCID: PMC10565120 DOI: 10.7759/cureus.45000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023] Open
Abstract
Central venous catheter (CVC)-based hemodialysis is a major contributor to bacteremia in immunocompromised hosts. Heparin-locking CVCs is a frequent therapeutic procedure. However, it has not been shown to reduce catheter-related bloodstream infections (CRBSIs). For this systematic review, we searched PubMed, PubMed Central, ResearchGate, Science Direct, and Multidisciplinary Digital Publishing Institute (MDPI) for multiple articles published between January 2018 and January 2023 to determine how antimicrobial locking solutions affect CRBSIs, which could ultimately lower the risk of morbidity, mortality, and hospitalization costs. Antilocking products, catheter-related bacteremia, central-line associated bloodstream infections, tunneled dialysis catheter, hemodialysis, antibiotic, and antimicrobial catheter locks, and the Medical Subject Heading (MeSH) method for PubMed were used as the main keywords for searching publications. A pool of 13 studies with 46,139 individuals showed that the therapy group had a lower incidence of CRBSIs than the heparin-treated control group. Furthermore, it was discovered that bacteria were resistant to gentamicin, and the use of antibiotics had no discernible impact on catheter malfunction. In conclusion, the most effective locking solution to date is an antilocking solution made up of an antibiotic or antimicrobial agent combined with low-dose heparin (500-2,500 U/mL).
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Affiliation(s)
- Ayesha Haq
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Deepkumar Patel
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sai Dheeraj Gutlapalli
- Internal Medicine, Richmond University Medical Center, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York City, USA
- Internal Medicine/Clinical Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Grethel N Hernandez
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Kofi D Seffah
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | - Mustafa Abrar Zaman
- Internal Medicine, St. George's University School of Medicine, Newcastle Upon Tyne, GBR
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Nimra Awais
- Clinical Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Travis Satnarine
- Pediatrics, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Areeg Ahmed
- Internal Medicine, California Institute of Neuroscience, Thousand Oaks, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Caetano CP, Cassimiro VP, Dionisio DL, Pereira VP, Rodrigues EAC, Rosa PN, Elias DA, Ponce D. Topical gentamicin for the prevention of tunneled hemodialysis catheter-related infections: a randomized double-blind study. J Nephrol 2023; 36:1889-1896. [PMID: 37140818 DOI: 10.1007/s40620-023-01615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/23/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Infection is the second leading cause of death in dialysis patients, with catheter-related bloodstream infection being the most serious. Exit Site Infection and Tunnel Infection are also related to the catheter. OBJECTIVE To compare the infection rates achieved with the application of either topical gentamicin or placebo to the exit-site of tunneled catheters filled with locking solution in chronic hemodialysis patients. METHODS This randomized double-blind clinical trial compared the application of 0.1% gentamicin versus placebo to the exit site of tunneled hemodialysis catheters filled with a prophylactic locking solution. A total of 91 patients were randomly allocated to 2 groups: placebo or 0.1% gentamicin. RESULTS Mean patient age was 60.4 (+ 15.3) years, with predominance of males (60.4%). The main cause of chronic kidney disease was diabetes (40.7%). The rates of exit site infection (placebo = 30% vs. gentamicin = 34.1%, p = 0.821), and bloodstream infection (placebo = 22% vs. gentamicin = 17.1%, p = 0.60), as well as both exit site infection and bloodstream infection incidence density per 1000 catheter-days (p = 1) did not differ between groups. The infection-free curve was also similar in both groups. CONCLUSION The application of topical 0.1% gentamicin to the exit site of tunneled catheters filled with lock solution did not reduce infectious complications when compared to topical placebo in patients on chronic hemodialysis.
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Affiliation(s)
- Camille Pereira Caetano
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil.
| | - Vanessa Piacitelli Cassimiro
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| | - Daniele Lopes Dionisio
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| | - Viviane Pollo Pereira
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| | | | - Priscila Nunes Rosa
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| | - Daniele Aparecida Elias
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| | - Daniela Ponce
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
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Cobo-Sánchez JL, Blanco-Mavillard I, Mancebo-Salas N, Moya-Mier S, González-Menéndez F, Renedo-González C, Lázaro-Otero M, Pelayo-Alonso R, Gancedo-González Z, de Pedro-Gómez JE. Early identification of local infections in central venous catheters for hemodialysis: A systematic review. J Infect Public Health 2023; 16:1023-1032. [PMID: 37178476 DOI: 10.1016/j.jiph.2023.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The use of central venous catheters (CVC) is associated with higher morbidity and mortality, related to infectious complications, contributing to poorer clinical outcomes and increased healthcare costs. According to the literature, the incidence of local infections related to CVC for hemodialysis is highly variable. This variability is related to differences in definitions of catheter-related infections. OBJECTIVE To identify signs and symptoms for determining local infections (exit site and tunnel tract infections) used in the literature in tunnelled and nontunnelled CVC for hemodialysis. DESIGN Systematic review METHODS: Structured electronic searches were conducted in five electronic databases, from 1 January 2000-31 August 2022, using key words and specific vocabulary, as well as manual searches in several journals. Additionally, vascular access clinical guidelines and infection control clinical guidelines were reviewed. RESULTS After validity analysis, we selected 40 studies and seven clinical guidelines. The definitions of exit site infection and tunnel infection used in the different studies were heterogeneous. Among the studies, seven (17,5 %) used the definitions of exit site and tunnel infection based on a clinical practice guideline. Three of the studies (7.5 %) used the Twardowski scale definition of exit site infection or a modification. The remaining 30 studies (75 %) used different combinations of signs and symptoms. CONCLUSIONS Definitions of local CVC infections are highly heterogeneous in the revised literature. It is necessary to establish a consensus regarding the definitions of hemodialysis CVC exit site and tunnel infections. REGISTRATION PROSPERO (CRD42022351097).
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Affiliation(s)
- José Luis Cobo-Sánchez
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain; Clínica Mompía School of Nursing, Universidad Católica de Ávila, Mompía, Spain
| | - Ian Blanco-Mavillard
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Implementation, Research and Innovation Unit, Hospital de Manacor, Manacor, Spain.
| | - Noelia Mancebo-Salas
- Dirección General de Servicios Sociales. Consejería de Familia, Juventud y Política Social, Comunidad de Madrid, Madrid, Spain
| | - Susana Moya-Mier
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain
| | | | | | - Mercedes Lázaro-Otero
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain; Faculty of Nursing, Universidad de Cantabria, Santander, Spain
| | | | - Zulema Gancedo-González
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain; Escoles Universitaries Gimbernat, Nursing School, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Joan Ernest de Pedro-Gómez
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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In Vivo Effectiveness of Several Antimicrobial Locks To Eradicate Intravascular Catheter Coagulase-Negative Staphylococci Biofilms. Antimicrob Agents Chemother 2023; 67:e0126422. [PMID: 36602372 PMCID: PMC9872714 DOI: 10.1128/aac.01264-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Tunneled central venous catheter (TCVC) related infection remains a challenge in the care of hemodialysis patients. We aimed to determine the best antimicrobial lock therapy (ALT) to eradicate coagulase-negative staphylococci (CoNS) biofilms. We studied the colonization status of the catheter every 30 days by quantitative blood cultures (QBC) drawn through all catheter lumens. Those patients with a significant culture (i.e.,100 to 1,000 CFU/mL) of a CoNS were classified as patients with a high risk of developing catheter-related bloodstream infections (CRBSI). They were assigned to receive daptomycin, vancomycin, teicoplanin lock solution, or the standard of care (SoC) (i.e., heparin lock). The primary endpoint was to compare eradication ability (i.e., negative QBC for 30 days after ending ALT) rates between different locks and the SoC. A second objective was to analyze the correlation between ALT exposure and isolation of CoNS with antimicrobial resistance. Daptomycin lock was associated with a significant higher eradication success than with the SoC: 85% versus 30% (relative risk [RR] = 14, 95% confidence interval [CI] = 2.4 - 82.7); followed by teicoplanin locks with a 83.3% success (RR = 11.7; 95% CI = 2 - 70.2). We observed CoNs isolates with a higher teicoplanin MIC in patients with repeated teicoplanin locks exposure (coefficient = 0.3; 95% CI = 0.11 - 0.47). However, teicoplanin MICs decreased in patients treated with vancomycin locks (coefficient = -0.56; 95% CI = -0.85 - -0.02). Methicillin-resistance decreased with accumulative ALT (RR = 0.82; 95% CI = 0.69 - 0.98). In this study, daptomycin locks achieve the highest eradication rate of CoNS from hemodialysis catheters in vivo.
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Wang Y, Sun X. Reevaluation of lock solutions for Central venous catheters in hemodialysis: a narrative review. Ren Fail 2022; 44:1501-1518. [PMID: 36047812 PMCID: PMC9448397 DOI: 10.1080/0886022x.2022.2118068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND A significant proportion of incident and prevalent hemodialysis patients have central venous catheters for vascular access. No consensus is available on the prevention of catheter dysfunction or catheter-related bloodstream infections in patients undergoing hemodialysis by means of catheter lock solutions. METHOD We reviewed the effects of single and combined anticoagulants with antibacterial catheter lock solutions or other antimicrobials for the prevention of thrombosis or infections in hemodialysis patients. Relative risks with 95% confidence intervals for trials of the same type of catheter locking solution were pooled. SOURCES OF INFORMATION We included original research articles in English from PubMed, EMBASE, SpringerLink, Elsevier and Ovid using the search terms 'hemodialysis,' 'central venous catheter,' 'locking solution,' 'UFH,' 'low molecular weight heparin,' 'EDTA,' 'citrate,' 'rt-PA,' 'urokinase,' 'gentamicin,' 'vancomycin', 'taurolidine,' 'sodium bicarbonate,' 'hypertonic saline' and 'ethanol' and 'catheter'. FINDINGS Low-dose heparin lock solution (< 5000 U/ml) can efficiently achieve anticoagulation and will not increase the risk of bleeding. Low-concentration citrate (< 5%) combined with rt-PA can effectively prevent catheter infection and dysfunction. Catheter-related infections may be minimized by choosing the appropriate antibiotic and dose. LIMITATIONS There is a lack of follow-up validation data for LMWH, EDTA, taurolidine, sodium bicarbonate, ethanol, and other lock solutions. IMPLICATIONS Since catheterization is common in hemodialysis units, studies on long-term treatment and preventative strategies for catheter dysfunction and catheter-related infection are warranted.
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Affiliation(s)
- Yiqin Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xuefeng Sun
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
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7
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Pook M, Zamir N, McDonald E, Fox-Robichaud A. Chlorhexidine (di)gluconate locking device for central line infection prevention in intensive care unit patients: a multi-unit, pilot randomized controlled trial. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S36-S46. [PMID: 35856588 DOI: 10.12968/bjon.2022.31.14.s36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Intensive care unit (ICU) patients are at risk for central line-associated bloodstream infection (CLABSI) with significant attributable mortality and increased hospital length of stay, readmissions, and costs. Chlorhexidine (di)gluconate (CHG) is used as a disinfectant for central line insertion; however, the feasibility and efficacy of using CHG as a locking solution is unknown. METHODS Patients with a central venous access device (CVAD) in situ were randomized to standard care or a CHG lock solution (CHGLS) within 72 hours of ICU admission. The CHG solution was instilled in the lumen of venous catheters not actively infusing. CVAD blood cultures were taken at baseline and every 48 hours. The primary outcome was feasibility including recruitment rate, consent rate, protocol adherence, and staff uptake. Secondary outcomes included CVAD colonization, bacteraemia, and clinical endpoints. RESULTS Of 3,848 patients screened, 122 were eligible for the study and consent was obtained from 82.0% of the patients or substitute decision makers approached. Fifty participants were allocated to each group. Tracking logs indicated that the CHGLS was used per protocol 408 times. Most nurses felt comfortable using the CHGLS. The proportion of central line colonization was significantly higher in the standard care group with 40 (29%) versus 26 (18.7%) in the CHGLS group (P=0.009). CONCLUSIONS Using a device that delivers CHG into CVADs was feasible in the ICU. Findings from this trial will inform a full-scale randomized controlled trial and provide preliminary data on the effectiveness of CHGLS. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03309137, registered on October 13, 2017.
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van den Bosch CH, Jeremiasse B, van der Bruggen JT, Frakking FNJ, Loeffen YGT, van de Ven CP, van der Steeg AFW, Fiocco MF, van de Wetering MD, Wijnen MHWA. The efficacy of taurolidine containing lock solutions for the prevention of central-venous-catheter-related bloodstream infections: a systematic review and meta-analysis. J Hosp Infect 2021; 123:143-155. [PMID: 34767871 DOI: 10.1016/j.jhin.2021.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/16/2021] [Accepted: 10/30/2021] [Indexed: 12/25/2022]
Abstract
The incidence of central venous catheter (CVC)-related bloodstream infections is high in patients requiring a long-term CVC. Therefore, infection prevention is of the utmost importance. The aim of this study was to provide an updated overview of randomized controlled trials (RCTs) comparing the efficacy of taurolidine containing lock solutions (TL) to other lock solutions for the prevention of CVC-related bloodstream infections in all patient populations. On 15th February 2021, PubMed, Embase and The Cochrane Library were searched for RCTs comparing the efficacy of TLs for the prevention of CVC-related bloodstream infections with other lock solutions. Exclusion criteria were non-RCTs, studies describing <10 patients and studies using TLs as treatment. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. A random effects model was used to pool individual study incidence rate ratios (IRRs). Subgroup analyses were performed based on the following factors: CVC indication, comparator lock and bacterial isolates cultured. A total of 14 articles were included in the qualitative synthesis describing 1219 haemodialysis, total parenteral nutrition and oncology patients. The pooled IRR estimated for all patient groups together (nine studies; 918 patients) was 0.30 (95% confidence interval 0.19-0.46), favouring the TLs. Adverse events (10 studies; 867 patients) were mild and scarce. The quality of the evidence was limited due to a high risk of bias and indirectness of evidence. The use of TLs might be promising for the prevention of CVC-related bloodstream infections. Large-scale RCTs are needed to draw firm conclusions on the efficacy of TLs.
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Affiliation(s)
- C H van den Bosch
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - B Jeremiasse
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - J T van der Bruggen
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F N J Frakking
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Y G T Loeffen
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - C P van de Ven
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - M F Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Mathematical Institute, Leiden, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | | | - M H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Piątkowska E, Paleczny J, Dydak K, Letachowicz K. Antimicrobial activity of hemodialysis catheter lock solutions in relation to other compounds with antiseptic properties. PLoS One 2021; 16:e0258148. [PMID: 34618850 PMCID: PMC8496847 DOI: 10.1371/journal.pone.0258148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022] Open
Abstract
Proper protection of vascular access after haemodialysis is one of the key measures for the prevention of catheter-related infections. Various substances with bactericidal and anticoagulant properties are used to fill catheters, but due to the unsatisfactory clinical effects and occurrence of adverse reactions, the search for new substances is still ongoing. In the present paper, we compared the in vitro antimicrobial activity of solutions used for tunnelled catheter locking (taurolidine, trisodium citrate) and solutions of substances that could potentially be used for this purpose (sodium bicarbonate, polyhexanide-betaine). The studies have been conducted on bacteria that most commonly cause catheter-related infections. The values of both minimum inhibitory concentration and minimum biofilm eradication concentration of the substances were determined. The ability of the tested substances to eradicate biofilm from the dialysis catheter surface was also evaluated. The results showed that polyhexanide-betaine inhibited the growth of all microbes comparably to taurolidine, even after ≥ 32-fold dilution. The activity of trisodium citrate and sodium bicarbonate was significantly lower. Polyhexanide exhibited the highest activity in the eradication of bacterial biofilm on polystyrene plates. The biofilm formed on a polyurethane dialysis catheter was resistant to complete eradication by the test substances. Polyhexanide-betaine and taurolidine showed the highest activity. Inhibition of bacterial growth regardless of species was observed not only at the highest concentration of these compounds but also after dilution 32-128x (taurolidine) and 32-1024x (polyhexanide-betaine). Therefore, it can be assumed that taurolidine application as a locking solution prevents catheter colonization and systemic infection development. Taurolidine displays high antimicrobial efficacy against Gram-positive cocci as well as Gram-negative bacilli. On the contrary, the lowest antibacterial effect displayed product contained sodium bicarbonate. The inhibitions of bacterial growth were not satisfactory to consider it as a substance for colonization prevention. Polyhexanidine-betaine possessed potent inhibitory and biofilm eradication properties comparing to all tested products. PHMB is applied as a wound irrigation solution worldwide. However, based on our results, we assume that the PHMB is a promising substance for catheter locking solutions thanks to its safety and high antimicrobial properties.
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Affiliation(s)
- Elżbieta Piątkowska
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, Wroclaw, Poland
| | - Justyna Paleczny
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, Wroclaw, Poland
| | - Karolina Dydak
- Department of Pharmaceutical Microbiology and Parasitology, Medical University of Wroclaw, Wroclaw, Poland
| | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Medical University of Wroclaw, Wroclaw, Poland
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Fisher M, Golestaneh L, Allon M, Abreo K, Mokrzycki MH. Prevention of Bloodstream Infections in Patients Undergoing Hemodialysis. Clin J Am Soc Nephrol 2019; 15:132-151. [PMID: 31806658 PMCID: PMC6946076 DOI: 10.2215/cjn.06820619] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bloodstream infections are an important cause of hospitalizations, morbidity, and mortality in patients receiving hemodialysis. Eliminating bloodstream infections in the hemodialysis setting has been the focus of the Centers for Disease Control and Prevention (CDC) Making Dialysis Safer for Patients Coalition and, more recently, the CDC's partnership with the American Society of Nephrology's Nephrologists Transforming Dialysis Safety Initiative. The majority of vascular access-associated bloodstream infections occur in patients dialyzing with central vein catheters. The CDC's core interventions for bloodstream infection prevention are the gold standard for catheter care in the hemodialysis setting and have been proven to be effective in reducing catheter-associated bloodstream infection. However, in the United States hemodialysis catheter-associated bloodstream infections continue to occur at unacceptable rates, possibly because of lapses in adherence to strict aseptic technique, or additional factors not addressed by the CDC's core interventions. There is a clear need for novel prophylactic therapies. This review highlights the recent advances and includes a discussion about the potential limitations and adverse effects associated with each option.
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Affiliation(s)
- Molly Fisher
- Division of Nephrology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Ladan Golestaneh
- Division of Nephrology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Kenneth Abreo
- Division of Nephrology, Louisiana State University Health at Shreveport, Shreveport, Louisiana
| | - Michele H Mokrzycki
- Division of Nephrology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York;
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