Taurolidine lock solutions
Background: 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.
Aim: To provide an updated overview of randomized controlled trials (RCT) comparing the efficacy of taurolidine containing lock solutions (TL) to other lock solutions for the prevention of CVC-related bloodstream infections in all patients populations.
Methods: On 15 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 (IRR). Subgroup analyses were performed based on the following factors: CVC indication, comparator lock and bacterial isolates cultured.
Findings: 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 (CI95% 0.19-0.46), favouring the TLs. Adverse events (ten 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.
Conclusion: 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.
van den Bosch CH, Jeremiasse B, van der Bruggen T, Frakking FNJ, Loeffen YGT, van de Ven CP, van der Steeg AFW, Fiocco MF, van de Wetering MD, Wijnen MHWA. Systematic review and meta-analysis: The efficacy of taurolidine containing lock solutions for the prevention of central venous catheter related bloodstream infections. J Hosp Infect. 2021 Nov 9:S0195-6701(21)00386-8. doi: 10.1016/j.jhin.2021.10.022. Epub ahead of print. PMID: 34767871.