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Recurrent catheter related bloodstream infections by Candida glabrata: Successful treatment with taurolidine
Clinical Nutrition 33 (2014) 367
Contents lists available at ScienceDirect
Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu
Letter to the Editor
Recurrent catheter related bloodstream infections by Candida glabrata: Successful treatment with taurolidine Dear Editor, We have read with great interest the paper by Olthof and coworkers,1 that reports the absence of microbial adaptation to taurolidine in patients on home parenteral nutrition (HPN) who develop catheter related bloodstream infections (CRBSI) and who use the taurolidine lock solutions. This finding is of extreme interest for the clinicians who manage patients on HPN, who are dependent on the central lines and who are at high risk of CRBSI. As reported, indeed, the repeated CRBSI, in patients with intestinal failure, can become an indication to the small bowel transplantation.2 Therefore is very important to prevent the septic episodes of the central lines. A previous pediatric survey has reported the efficacy of the taurolidine line lock in patients on HPN to decrease the incidence of CRBSI.3 In this report the Authors suggested that the use of taurolidine lock solutions should be approached in patients with a history of septicemia on treatment with cyclical parenteral nutrition (PN).3 In line with this previously reported experience,3 also our pediatric patients on HPN (currently 40 patients) switched from low-dose heparin (100 mI/mL) to taurolidine catheter locking by the beginning of the year 2013. The inclusion criteria for starting the taurolidine lock in our institution are the following: 1) clinical history positive for at least one episodes of CRBSI in the last year of HPN and 2) admission due to an episode of central line sepsis; in this clinical setting the taurolidine is started when the antibiotic therapy for the episode is concluded. Up to now we have treated three patients; one out of them suffered from repeated episodes of CRBSI by Candida glabrata. He is a 3-years-old boy with a history of neonatal volvulus with intestinal resection at three months of life, with residual intestinal length of 5 cm and loss of the ileocecal valve and of the 50% of the colon. When the child was admitted for the first time to our hospital he had a Broviac catheter, that was the sixth such catheter placed for PN. The last two catheters were removed because of the fungal infection by C. glabrata could not be cleared with systemic antifungal agents (liposomal amphotericin-B and caspofungin). Since the patient started the taurolidine lock no more central line sepsis by C. glabrata or other
microbial agents were observed. To our knowledge, this is the first case of a patient with repeated and severe C. glabrata central line sepsis who was successfully treated with taurolidine locks. This experience confirms that, also at pediatric age, this drug can be considered an effective tool to optimize the management of the patients that needs long-term PN. Conflict of interest We have not conflict of interest to declare. References 1. Olthof ED, Rentenaar RJ, Rijs AJMM, Wanten GJA. Absence of microbial adaptation to taurolidine in patients on home parenteral nutrition who develop catheter related bloodstream infections and use taurolidine locks. Clin Nutr 2013;32:538e42. 2. Kaufman SS, Atkinson JB, Bianchi A, Goulet OJ, Grant D, Langnas AN, et al. Indications for paediatric intestinal transplantation: a position paper of the American Society of Transplantation. Pediatr Transplant 2001;5:80e7. 3. Chu HP, Brind J, Tomar R, Hill S. Significant reduction in central venous catheterrelated bloodstream infections in children on HPN after starting treatment with taurolidine line lock. J Pediatr Gastroenterol Nutr 2012;55:403e7.
Antonella Diamanti*, Teresa Capriati Artificial Nutrition Unit, Bambino Gesù Children’s Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy Anna Iacono Pharmacy Service, Bambino Gesù Children’s Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy * Corresponding
author. Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù “Children Hospital”, Piazza S. Onofrio 4, 00165 Rome, Italy. Tel.: þ39 668592339; fax: þ39 668593889. E-mail address: [email protected] (A. Diamanti).
DOI of original article: http://dx.doi.org/10.1016/j.clnu.2014.01.007. 0261-5614/$ e see front matter Ó 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. http://dx.doi.org/10.1016/j.clnu.2014.01.010
10 November 2013
Contents lists available at ScienceDirect
Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu
Letter to the Editor
Recurrent catheter related bloodstream infections by Candida glabrata: Successful treatment with taurolidine Dear Editor, We have read with great interest the paper by Olthof and coworkers,1 that reports the absence of microbial adaptation to taurolidine in patients on home parenteral nutrition (HPN) who develop catheter related bloodstream infections (CRBSI) and who use the taurolidine lock solutions. This finding is of extreme interest for the clinicians who manage patients on HPN, who are dependent on the central lines and who are at high risk of CRBSI. As reported, indeed, the repeated CRBSI, in patients with intestinal failure, can become an indication to the small bowel transplantation.2 Therefore is very important to prevent the septic episodes of the central lines. A previous pediatric survey has reported the efficacy of the taurolidine line lock in patients on HPN to decrease the incidence of CRBSI.3 In this report the Authors suggested that the use of taurolidine lock solutions should be approached in patients with a history of septicemia on treatment with cyclical parenteral nutrition (PN).3 In line with this previously reported experience,3 also our pediatric patients on HPN (currently 40 patients) switched from low-dose heparin (100 mI/mL) to taurolidine catheter locking by the beginning of the year 2013. The inclusion criteria for starting the taurolidine lock in our institution are the following: 1) clinical history positive for at least one episodes of CRBSI in the last year of HPN and 2) admission due to an episode of central line sepsis; in this clinical setting the taurolidine is started when the antibiotic therapy for the episode is concluded. Up to now we have treated three patients; one out of them suffered from repeated episodes of CRBSI by Candida glabrata. He is a 3-years-old boy with a history of neonatal volvulus with intestinal resection at three months of life, with residual intestinal length of 5 cm and loss of the ileocecal valve and of the 50% of the colon. When the child was admitted for the first time to our hospital he had a Broviac catheter, that was the sixth such catheter placed for PN. The last two catheters were removed because of the fungal infection by C. glabrata could not be cleared with systemic antifungal agents (liposomal amphotericin-B and caspofungin). Since the patient started the taurolidine lock no more central line sepsis by C. glabrata or other
microbial agents were observed. To our knowledge, this is the first case of a patient with repeated and severe C. glabrata central line sepsis who was successfully treated with taurolidine locks. This experience confirms that, also at pediatric age, this drug can be considered an effective tool to optimize the management of the patients that needs long-term PN. Conflict of interest We have not conflict of interest to declare. References 1. Olthof ED, Rentenaar RJ, Rijs AJMM, Wanten GJA. Absence of microbial adaptation to taurolidine in patients on home parenteral nutrition who develop catheter related bloodstream infections and use taurolidine locks. Clin Nutr 2013;32:538e42. 2. Kaufman SS, Atkinson JB, Bianchi A, Goulet OJ, Grant D, Langnas AN, et al. Indications for paediatric intestinal transplantation: a position paper of the American Society of Transplantation. Pediatr Transplant 2001;5:80e7. 3. Chu HP, Brind J, Tomar R, Hill S. Significant reduction in central venous catheterrelated bloodstream infections in children on HPN after starting treatment with taurolidine line lock. J Pediatr Gastroenterol Nutr 2012;55:403e7.
Antonella Diamanti*, Teresa Capriati Artificial Nutrition Unit, Bambino Gesù Children’s Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy Anna Iacono Pharmacy Service, Bambino Gesù Children’s Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy * Corresponding
author. Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù “Children Hospital”, Piazza S. Onofrio 4, 00165 Rome, Italy. Tel.: þ39 668592339; fax: þ39 668593889. E-mail address: [email protected] (A. Diamanti).
DOI of original article: http://dx.doi.org/10.1016/j.clnu.2014.01.007. 0261-5614/$ e see front matter Ó 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. http://dx.doi.org/10.1016/j.clnu.2014.01.010
10 November 2013