Betjes Michiel G H, van Agteren Madelon
Department of Internal Medicine, Division of Nephrology, Erasmus Medical Center, Dijkzigt Rotterdam, Dr Molewater plein 40, 3015 GD Rotterdam, The Netherlands.
Nephrol Dial Transplant. 2004 Jun;19(6):1546-51. doi: 10.1093/ndt/gfh014. Epub 2004 Feb 19.
The use of haemodialysis catheters is complicated by catheter-related sepsis. Intraluminal colonization of the catheter with bacteria is important in the pathogenesis of catheter-related sepsis. The use of a catheter lock solution containing the antimicrobial taurolidine might prevent bacterial colonization, thereby reducing the incidence of catheter-related sepsis.
In a randomized prospective trial, patients receiving a dialysis catheter were included and catheters were locked with either heparin or a citrate-taurolidine-containing solution. Blood cultures drawn from the catheter lumen were routinely taken every 2 weeks and at time of removal of the catheter to detect bacterial colonization. Catheter-related sepsis and exit-site infections were registered for both groups.
A total of 76 catheters were inserted in 58 patients. The incidence of catheter colonization progressed slowly over time with no differences between dialysis catheters filled with heparin or citrate-taurolidine-containing solution. The number of exit-site infections was also similar between both groups. In the heparin group, four cases of catheter-related sepsis occurred as opposed to no sepsis episodes in the patients with catheters locked with the citrate-taurolidine-containing solution (P<0.5). No side effects with the use of citrate-taurolidine catheter lock solution were noted.
This study shows that catheter filling with a solution containing the antimicrobial taurolidine may significantly reduce the incidence of catheter-related sepsis. Taurolidine appears to be effective and safe and does not carry the risk for side effects that have been reported for other antimicrobial lock solutions containing gentamicin or high concentrations of citrate.
血液透析导管的使用因导管相关败血症而变得复杂。导管腔内细菌定植在导管相关败血症的发病机制中很重要。使用含有抗菌剂牛磺罗定的导管封管溶液可能会防止细菌定植，从而降低导管相关败血症的发生率。
在一项随机前瞻性试验中，纳入接受透析导管的患者，并分别用肝素或含枸橼酸盐 - 牛磺罗定的溶液封管。每2周常规从导管腔内采集血培养样本，并在拔除导管时采集，以检测细菌定植情况。记录两组的导管相关败血症和出口部位感染情况。
共58例患者插入了76根导管。随着时间推移，导管定植发生率缓慢上升，用肝素封管的透析导管与用含枸橼酸盐 - 牛磺罗定溶液封管的透析导管之间无差异。两组出口部位感染数量也相似。肝素组发生了4例导管相关败血症，而用含枸橼酸盐 - 牛磺罗定溶液封管的患者未发生败血症（P<0.5）。未观察到使用含枸橼酸盐 - 牛磺罗定导管封管溶液的副作用。
本研究表明，用含有抗菌剂牛磺罗定的溶液封管可显著降低导管相关败血症的发生率。牛磺罗定似乎有效且安全，不存在已报道的含庆大霉素或高浓度枸橼酸盐的其他抗菌封管溶液的副作用风险。
