This study aimed to compare the efficacy of LS using a combination of cefazolin and gentamicin versus taurolidine and citrate in reducing CR-BSI in patients undergoing HD and to identify any adverse effects” Bueloni et al (2019).
Abstract:
BACKGROUND: Catheter-related bloodstream infections (CR-BSI) is one of the various complications related to haemodialysis (HD). As a result of the high rate of infection, the lock solutions (LS) has been studied to prevent CRB. However, adverse effects of LS, such as increased emergence of strains resistant to antibiotics, which is an important concern, need to be further investigated. This study aimed to compare the efficacy of LS using a combination of cefazolin and gentamicin versus taurolidine and citrate in reducing CR-BSI in patients undergoing HD and to identify any adverse effects.
METHODS: A prospective observational study was performed in two dialysis centres, and included patients using new tunnelled central venous catheters (CVC) for HD. Patients with a tunnelled CVC were assigned to receive either antibiotic LS (group 1: gentamicin 7 mg/ml + cefazolin 12 mg/ml + heparin 3500 IU/ml) or an LS with TauroLock™-Hep500 (group 2: taurolidine citrate 4% + heparin 500 IU/ml) during the interdialytic period. The patients were allocated into these groups according to the which haemodialysis centre they were at.
RESULTS: A total of 145 CVC were implanted in 127 patients and were followed for 15 months: 65 patients (77 CVC) were placed in group 1 (G1) and 62 patients (68 CVC) in group 2 (G2). There was no difference between the two groups in regard to CR-BSI (G1 = 0.79, G2 = 1.10 events per 1,000 catheter-days, p = 0.18) and exit site infection (ESI) rates (G1 = 2.45, G2 = 1.83 events per 1,000 catheter-days, p = 0.37). The groups differed in ESI pathogens, where gram-positive oxacillin-resistant pathogens were more frequent in G1 (31.8% vs. 5.0%, p = 0.003). The two groups were similar in mechanical complications. In the Cox regression analysis, the internal jugular vein site was a protective factor for all for catheter removal complications (HR: 0.41, 95% CI: 0.19-0.91) and mechanical complications (HR: 0.16, 95% CI: 0.065-0.41); only ESI was a risk factor for all catheter removal complications (HR: 1.79, 95% CI: 1.04-3.07) and mechanical complication (HR: 5.64, 95% CI: 1.65-19.3).
CONCLUSION: The efficacy of both lock solutions was similar in preventing infections related to tunnelled CVC for HD; however, there were more oxacillin-resistant strains in patients who received antibiotic lock solution. Further studies are required to determine the optimal drug regimen and concentrations for LS and the associated adverse effects.
You may also be interested in…
[rp4wp]
[button link=”https://www.ijidonline.com/article/S1201-9712(19)30223-1/pdf” color=”default”]Full Text[/button]
[spacer height=”20px”]
Reference:
Bueloni, T.N.V., Marchi, D., Caetano, C., Cavalcante, R.S., Amaral, M.L.M. and Ponce, D. (2019) Cefazolin/gentamicin versus taurolidine/citrate for prevention of infection in tunnelled central catheter in haemodialysis patients: a quasi-experimental trial. International Journal of Infectious Diseases. May 15th. doi: 10.1016/j.ijid.2019.05.017.