TY - JOUR
T1 - Taurolidine-citrate-heparin lock reduces catheter-related bloodstream infections in intestinal failure patients dependent on home parenteral support
T2 - a randomized, placebo-controlled trial
AU - Tribler, Siri
AU - Brandt, Christopher F.
AU - Petersen, Anne H.
AU - Petersen, Jørgen H.
AU - Fuglsang, Kristian A.
AU - Staun, Michael
AU - Broebech, Per
AU - Moser, Claus E.
AU - Jeppesen, Palle B.
N1 - © 2017 American Society for Nutrition.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Background: In patients with intestinal failure who are receiving home parenteral support (HPS), catheter-related bloodstream infections (CRBSIs) inflict health impairment and high costs. Objective: This study investigates the efficacy and safety of the antimicrobial catheter lock solution, taurolidine-citrate-heparin, compared with heparin 100 IE/mL on CRBSI occurrence. Design: Forty-one high-risk patients receiving HPS followed in a tertiary HPS unit were randomly assigned in a double-blinded, placebo-controlled trial. External, stratified randomization was performed according to age, sex, and prior CRBSI incidence. The prior CRBSI incidence in the study population was 2.4 episodes/1000 central venous catheter (CVC) days [95% Poisson confidence limits (CLs): 2.12, 2.71 episodes/1000 CVC days]. The maximum treatment period was 2 y or until occurrence of a CRBSI or rightcensoring because of CVC removal. The exact permutation tests were used to calculate P values for the log-rank tests. Results: Twenty patients received the taurolidine-citrate-heparin lock and 21 received the heparin lock, with 9622 and 6956 treatment days, respectively. In the taurolidine-citrate-heparin arm, no CRBSIs occurred, whereas 7 CRBSIs occurred in the heparin arm, with an incidence of 1.0/1000 CVC days (95% Poisson CLs: 0.4, 2.07/1000 CVC days; P = 0.005). The CVC removal rates were 0.52/1000 CVC days (95% Poisson CLs: 0.17, 1.21/1000 CVC days) and 1.72/1000 CVC days (95% Poisson CLs: 0.89, 3.0/1000 CVC days) in the taurolidine-citrate-heparin and heparin arm, respectively, tending to prolong CVC survival in the taurolidine arm (P = 0.06). Costs per treatment year were lower in the taurolidine arm (2348) than in the heparin arm (6744) owing to fewer admission days related to treating CVC-related complications (P = 0.02). Conclusions: In patients with intestinal failure who are life dependent on HPS, the taurolidine-citrate-heparin catheter lock demonstrates a clinically substantial and cost-beneficial reduction of CRBSI occurrence in a high-risk population compared with heparin.
AB - Background: In patients with intestinal failure who are receiving home parenteral support (HPS), catheter-related bloodstream infections (CRBSIs) inflict health impairment and high costs. Objective: This study investigates the efficacy and safety of the antimicrobial catheter lock solution, taurolidine-citrate-heparin, compared with heparin 100 IE/mL on CRBSI occurrence. Design: Forty-one high-risk patients receiving HPS followed in a tertiary HPS unit were randomly assigned in a double-blinded, placebo-controlled trial. External, stratified randomization was performed according to age, sex, and prior CRBSI incidence. The prior CRBSI incidence in the study population was 2.4 episodes/1000 central venous catheter (CVC) days [95% Poisson confidence limits (CLs): 2.12, 2.71 episodes/1000 CVC days]. The maximum treatment period was 2 y or until occurrence of a CRBSI or rightcensoring because of CVC removal. The exact permutation tests were used to calculate P values for the log-rank tests. Results: Twenty patients received the taurolidine-citrate-heparin lock and 21 received the heparin lock, with 9622 and 6956 treatment days, respectively. In the taurolidine-citrate-heparin arm, no CRBSIs occurred, whereas 7 CRBSIs occurred in the heparin arm, with an incidence of 1.0/1000 CVC days (95% Poisson CLs: 0.4, 2.07/1000 CVC days; P = 0.005). The CVC removal rates were 0.52/1000 CVC days (95% Poisson CLs: 0.17, 1.21/1000 CVC days) and 1.72/1000 CVC days (95% Poisson CLs: 0.89, 3.0/1000 CVC days) in the taurolidine-citrate-heparin and heparin arm, respectively, tending to prolong CVC survival in the taurolidine arm (P = 0.06). Costs per treatment year were lower in the taurolidine arm (2348) than in the heparin arm (6744) owing to fewer admission days related to treating CVC-related complications (P = 0.02). Conclusions: In patients with intestinal failure who are life dependent on HPS, the taurolidine-citrate-heparin catheter lock demonstrates a clinically substantial and cost-beneficial reduction of CRBSI occurrence in a high-risk population compared with heparin.
KW - Adult
KW - Aged
KW - Bacteremia
KW - Catheter-Related Infections
KW - Central Venous Catheters
KW - Citrates
KW - Cost-Benefit Analysis
KW - Female
KW - Heparin
KW - Humans
KW - Incidence
KW - Intestinal Diseases
KW - Intestines
KW - Male
KW - Middle Aged
KW - Parenteral Nutrition, Home
KW - Taurine
KW - Thiadiazines
KW - Journal Article
KW - Randomized Controlled Trial
U2 - 10.3945/ajcn.117.158964
DO - 10.3945/ajcn.117.158964
M3 - Journal article
C2 - 28793993
SN - 0002-9165
VL - 106
SP - 839
EP - 848
JO - The American Journal of Clinical Nutrition
JF - The American Journal of Clinical Nutrition
IS - 3
ER -