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Response to the letter to the editor - Practical considerations in choosing a taurolidine containing catheter lock solution
Clinical Nutrition 33 (2014) 371
Contents lists available at ScienceDirect
Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu
Reply
Response to the letter to the editor - Practical considerations in choosing a taurolidine containing catheter lock solution We thank Dr. Diamanti and colleagues for their interest in our study. Their letter entitled “Recurrent catheter related bloodstream infections by Candida glabrata: successful treatment with taurolidine” describes the switch from catheter lock solution heparin to taurolidine in pediatric home parenteral nutrition (HPN) patients who already developed catheter related bloodstream infections (CRBSI) in the past and who were submitted to the hospital for treatment of a CRBSI. We agree, that especially HPN patients with a high risk for a CRBSI can benefit from catheter locks containing taurolidine. An important issue that remains to be solved is whether taurolidine should be used in all HPN patients in order to prevent catheter colonization and intraluminal biofilm development. In contrast to Dr. Diamanti and colleagues who seem to suggest to use taurolidine in the treatment of CRBSI, we would like to emphasize that taurolidine is especially useful in the prevention of CRBSI, since this broad spectrum microbiocidal agent chemically reacts with the cell membrane of Gram negative bacteria and thereby inhibits both pathogenicity and microbial adhesion, thus catheter colonization.1 We also switched from heparin to taurolidine in our HPN population, after we showed in a prospective open-label randomized controlled trial in 30 HPN patients presenting with CRBSI that catheter locking with 2% taurolidine dramatically (90%) reduced re-infections compared with low-dose (150 U/ ml) heparin.2 Unfortunately, it is not clear from the letter of Dr. Diamanti and colleagues which taurolidine containing solution was used to lock the catheters. Several concentrations of taurolidine solutions are commercially available, some of which also contain anticoagulants like citrate and/or heparin. It is unknown whether these different taurolidine-containing formulations differ in effectiveness with regard to the prevention of CRBSI. Several questions remain to be answered in the setting of HPN concerning the effectiveness of the various catheter locks. For instance, is taurolidine really necessary or should only the use of
heparine be avoided and can saline be used as well. Also, are there other patient-, HPN- and catheter related risk factors that determine the risk for CRBSI?3 To be able to correct for these other risk factors and to study a larger HPN patient population, a multicenter randomized controlled trial investigating the effectiveness of taurolidine and saline in preventing CRBSI is deemed necessary and currently underway for adult HPN patients (ClinicalTrials.gov Identifier NCT01826526).
References 1. Caruso F, Darnowski JW, Opazo C, Goldberg A, Kishore N, Agoston ES, et al. Taurolidine antiadhesive properties on interaction with E. coli; its transformation in biological environment and interaction with bacteria cell wall. PLoS One 2010;5: e8927. 2. Bisseling TM, Willems MC, Versleijen MW, Hendriks JC, Vissers RK, Wanten GJ. Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: a heparin-controlled prospective trial. Clin Nutr 2010;29:464e8. 3. Dreesen M, Foulon V, Spriet I, Goossens GA, Hiele M, De Pourcq L, et al. Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: a systematic review. Clin Nutr 2013;32:16e26.
E.D. Olthof, G.J.A. Wanten* Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands * Corresponding author. Radboud University Nijmegen Medical Centre, Gastroenterology and Hepatology, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands. Tel.: þ31 (0) 24 3686472; fax: þ31 (0) 24 3540103. E-mail addresses: [email protected], [email protected] (E.D. Olthof), [email protected] (G.J.A. Wanten).
DOI of original article: http://dx.doi.org/10.1016/j.clnu.2014.01.010. 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.2014.01.007
13 January 2014
Contents lists available at ScienceDirect
Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu
Reply
Response to the letter to the editor - Practical considerations in choosing a taurolidine containing catheter lock solution We thank Dr. Diamanti and colleagues for their interest in our study. Their letter entitled “Recurrent catheter related bloodstream infections by Candida glabrata: successful treatment with taurolidine” describes the switch from catheter lock solution heparin to taurolidine in pediatric home parenteral nutrition (HPN) patients who already developed catheter related bloodstream infections (CRBSI) in the past and who were submitted to the hospital for treatment of a CRBSI. We agree, that especially HPN patients with a high risk for a CRBSI can benefit from catheter locks containing taurolidine. An important issue that remains to be solved is whether taurolidine should be used in all HPN patients in order to prevent catheter colonization and intraluminal biofilm development. In contrast to Dr. Diamanti and colleagues who seem to suggest to use taurolidine in the treatment of CRBSI, we would like to emphasize that taurolidine is especially useful in the prevention of CRBSI, since this broad spectrum microbiocidal agent chemically reacts with the cell membrane of Gram negative bacteria and thereby inhibits both pathogenicity and microbial adhesion, thus catheter colonization.1 We also switched from heparin to taurolidine in our HPN population, after we showed in a prospective open-label randomized controlled trial in 30 HPN patients presenting with CRBSI that catheter locking with 2% taurolidine dramatically (90%) reduced re-infections compared with low-dose (150 U/ ml) heparin.2 Unfortunately, it is not clear from the letter of Dr. Diamanti and colleagues which taurolidine containing solution was used to lock the catheters. Several concentrations of taurolidine solutions are commercially available, some of which also contain anticoagulants like citrate and/or heparin. It is unknown whether these different taurolidine-containing formulations differ in effectiveness with regard to the prevention of CRBSI. Several questions remain to be answered in the setting of HPN concerning the effectiveness of the various catheter locks. For instance, is taurolidine really necessary or should only the use of
heparine be avoided and can saline be used as well. Also, are there other patient-, HPN- and catheter related risk factors that determine the risk for CRBSI?3 To be able to correct for these other risk factors and to study a larger HPN patient population, a multicenter randomized controlled trial investigating the effectiveness of taurolidine and saline in preventing CRBSI is deemed necessary and currently underway for adult HPN patients (ClinicalTrials.gov Identifier NCT01826526).
References 1. Caruso F, Darnowski JW, Opazo C, Goldberg A, Kishore N, Agoston ES, et al. Taurolidine antiadhesive properties on interaction with E. coli; its transformation in biological environment and interaction with bacteria cell wall. PLoS One 2010;5: e8927. 2. Bisseling TM, Willems MC, Versleijen MW, Hendriks JC, Vissers RK, Wanten GJ. Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: a heparin-controlled prospective trial. Clin Nutr 2010;29:464e8. 3. Dreesen M, Foulon V, Spriet I, Goossens GA, Hiele M, De Pourcq L, et al. Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: a systematic review. Clin Nutr 2013;32:16e26.
E.D. Olthof, G.J.A. Wanten* Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands * Corresponding author. Radboud University Nijmegen Medical Centre, Gastroenterology and Hepatology, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands. Tel.: þ31 (0) 24 3686472; fax: þ31 (0) 24 3540103. E-mail addresses: [email protected], [email protected] (E.D. Olthof), [email protected] (G.J.A. Wanten).
DOI of original article: http://dx.doi.org/10.1016/j.clnu.2014.01.010. 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.2014.01.007
13 January 2014