We aimed to determine whether a lock solution with taurolidine-citrate-heparin would be more effective than placebo for preventing non-tunnelled CVC infection in high-risk neutropenic hematologic patients” Gudiol et al (2019).
Background: Infection of long-term central venous catheters (CVCs) remains a challenge in the clinical management of cancer patients. We aimed to determine whether a lock solution with taurolidine-citrate-heparin would be more effective than placebo for preventing non-tunnelled CVC infection in high-risk neutropenic hematologic patients.
Methods: We performed a prospective, multicentre, randomized (1:1), double-blind, parallel, superiority, placebo-controlled trial involving 150 hematological patients with neutropenia carrying non-tunnelled CVCs, who were assigned to receive CVC lock solution with taurolidine-citrate-heparin or heparin alone. Primary endpoint was bacterial colonization of the CVC hubs. Secondary endpoints were incidence of catheter-related bloodstream infection (CRBSI), CVC removal, adverse events related to the lock solution, and 30-day case-fatality rate.
Results: CVC lock with taurolidine-citrate-heparin was associated with less colonization of the CVC hubs when compared with placebo, with no statistically significant differences: 4.1%, vs. 10.1% (RR = 0.41, 95% CI 0.11-1.52), with a cumulative incidence of 4.17 (95% CI 0.87-11.70) and 10.14 (95% CI 4.18-19.79), respectively. There were no significant differences regarding the secondary endpoints. Only three episodes of CRBSI occurred during the study period. No adverse events related to the administration of the lock solution occurred.
Conclusions: In this trial involving high-risk patients carrying non-tunnelled CVCs, the use of taurolidine-citrate-heparin did not show benefit over placebo. Nevertheless, the safety of this prevention strategy and the trend towards less hub colonization in the taurolidine-citrate-heparin group raise the interest in assessing its efficacy in centers with higher rates of CRBSI.
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Gudiol, C., Arnan, M., Aguilar-Guisado, M., Royo-Cebrecos, C., Sánchez-Ortega, I., Montero, I., Martín-Gandul, C., Laporte-Amargós, J., Albasanz-Puig, A., Nicolae, S., Perayre, M., Berbel, D., Tebe, C., Riera, J., Sureda, A., Cisneros, J.M. and Carratalà, J. (2019) Taurolidine-citrate lock solution for prevention of endoluminal central venous catheter infection in neutropenic hematological patients: a randomized, double-blind, placebo-controlled trial (TAURCAT). Antimicrobial Agents and Chemotherapy. November 11th. doi: 10.1128/AAC.01521-19. .