Introduction Catheter related blood stream infections (CRBSI) in patients receiving home parenteral nutrition (HPN) cause significant morbidity, are potentially life-threatening and through repeated line replacements may compromise venous access. We introduced products containing taurolidine as preventative antimicrobial line locks in 2006 for HPN patients who had repeated episodes of CRBSI and report the incidence of CRBSI before and after.
Methods Data were retrospectively collected from electronic and paper records for all adult HPN patients between January 2001 and October 2011.
Results Data were available for 19/22 HPN patients receiving taurolidine locks for a period of 51.9 patient years (21.5 years pre-taurolidine and 30.4 years post-taurolidine). Patients were offered taurolidine if they had: (1) two or more episodes of community borne CRBSI (2) one episode of CRBSI in patients with a persistent source of intra-abdominal sepsis (3) significantly compromised vascular access. The use of taurolidine significantly reduced the rate of CRBSI from 4.59 to 0.81 episodes per 1000 days (p<0.0001). Nine episodes of recurrent CRBSI occurred in five patients despite taurolidine (one patient had four further infections in 5.6 years). The organisms responsible were coag neg staph. (four episodes), pseudomonas (one episode), candida (one episode), mixed coliform and coag neg staph (one episode) and two cases which were culture negative.
Conclusion Our experience shows that taurolidine significantly reduces the rate of CRBSI, particularly in patients who have had at least two previous infections. It may also have a role in preventing infection in patients with foci of potential abdominal sepsis in the context of type 2 IF. Despite this, it should not be seen as a substitute for meticulous line access techniques as some patients continue to develop recurrent infections while on treatment.
Competing interests None declared.
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