Central venous catheters and catheter locks in children with cancer: A prospective randomized trial of taurolidine versus heparin

TLDR: To determine if the catheter lock taurolidine can reduce the number of catheter‐related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC),

Abstract: Central venous catheters (CVC) are an inevitable part of thetreatment of children with cancer. Although many attempts havebeen made to reduce the risk of catheter-related infections, CVCsremain a major risk factor of bloodstream infections [1–4]. Stud-ies have shown that biofilm develops quickly once a CVC isinserted into a patient [5]. Bacteria living in a biofilm can bevery difficult to eradicate and are likely to be involved in casesof recurrent CRBSI [5,6].Heparin is often used to lock the catheter to prevent clottingwhen the catheter is not in use although heparin may enhance thegrowth of bacteria and the biofilm formation [7]. A Cochranereview has found prophylactic antibiotic catheter-lock to be ben-eficial in preventing CRBSI, but it is not routinely recommendeddue to the risk of selecting resistant microorganisms [8,9].Taurolidine is derived from the naturally occurring amino-sulphonic acid taurinamide and formaldehyde [10]. Taurolidineand its active metabolites contain an activeN-methylol groupthat cross-links with the protein part of the bacterial cell walland thereby neutralizes endotoxins and probably also to someextent exotoxins [11,12]. Taurolidine has also been reported tohave anti-adherence properties [13] and may reduce biofilmformation [14–16]. The substance has shown a broad spectrumof antimicrobial activity against both gram-positive and gram-negative bacteria as well as fungi. Taurolidine used as a cathe-ter-lock has shown efficacy in preventing CRBSI in adultpatients [17,18]. One non-randomized study of the use oftaurolidine as a catheter-lock in children with cancer reducedthe rate of gram-positive bloodstream infections [19]. Nointrinsic microbial resistance towards taurolidine has beenreported [20].We report the result of a prospective, randomized, controlledopen-label study in which CVCs locked with a taurolidine solu-tion were compared to CVCs locked with a standard heparinsolution.