Taurolidine lock solution in neonates
Background: Taurolidine lock, a technique used to prevent or treat catheter-related bloodstream infections (CRBSI), is effective in adult and pediatric patients but has been described rarely in neonates. The aim of this descriptive retrospective study, was to determine the feasibility and direct outcomes of prophylactic and therapeutic taurolidine locks in term and preterm neonates.
Methods: We implemented the use of therapeutic taurolidine lock in addition to antibiotic treatment with the aim of catheter salvage in critical neonates with difficult vascular access (group 1). In addition, we introduced taurolidine lock as a preventive measure in neonates with a central venous catheter (CVC) at high risk of developing CRBSI (group 2). Every 24 hours (in the treatment group) a 2% taurolidine solution was injected and the catheter locked for at least 120 minutes, until infection clearance (group 1). In the preventive group, the catheter was locked for 30 minutes every 48 hours until CVC removal (group 2).
Findings: 37 neonates who received taurolidine were included in this study. We did not observe any major adverse event. In group 1 (21 cases), clinical symptom disappearance and bacteremia clearance were achieved without catheter removal in 18 cases (85.7%); in the other 3 neonates the catheter was removed shortly after the start of the locks as it was possible to replace the CVC. In group 2 (16 neonates), no CRBSI was observed during the duration of the catheter placement.
Interpretation: In this retrospective study, taurolidine was successfully used in neonates both for prevention and treatment of CRBSI, without major undesired effects. A larger cohort and a randomized clinical trial is warranted in order to establish its efficacy and safety in neonates.
Savarese I, Yazami S, De Rose DU, Carkeek K, Campi F, Auriti C, Danhaive O, Piersigilli F. Use of 2% taurolidine lock solution for treatment and prevention of catheter-related bloodstream infections in neonates: a feasibility study. J Hosp Infect. 2023 Nov 14:S0195-6701(23)00369-9. doi: 10.1016/j.jhin.2023.11.003. Epub ahead of print. PMID: 37972710.