Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
Neonatal Intensive Care Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium.
J Hosp Infect. 2024 Jan;143:76-81. doi: 10.1016/j.jhin.2023.11.003. Epub 2023 Nov 14.
Taurolidine lock, a technique used to prevent or treat catheter-related bloodstream infection (CRBSI), is effective in adult and paediatric patients but has been described rarely in neonates. The aim of this descriptive retrospective study, was to determine the feasibility and direct outcomes of prophylactic and therapeutic taurolidine locks in term and preterm neonates.
We implemented the use of therapeutic taurolidine lock in addition to antibiotic treatment with the aim of catheter salvage in critical neonates with difficult vascular access (group 1). In addition, we introduced taurolidine lock as a preventive measure in neonates with a central venous catheter (CVC) at high risk of developing CRBSI (group 2). Every 24 h (in the treatment group) a 2% taurolidine solution was injected and the catheter locked for at least 120 min, until infection clearance (group 1). In the preventive group, the catheter was locked for 30 min every 48 h until CVC removal (group 2).
Thirty-seven neonates who received taurolidine were included in this study. We did not observe any major adverse events. In group 1 (21 cases), clinical symptom disappearance and bacteraemia clearance were achieved without catheter removal in 18 cases (85.7%); in the other three neonates the catheter was removed shortly after the start of the locks as it was possible to replace the CVC. In group 2 (16 neonates), no CRBSI was observed during the duration of the catheter placement.
In this retrospective study, taurolidine was successfully used in neonates both for prevention and treatment of CRBSI, without major undesired effects. A larger cohort and a randomized clinical trial is warranted in order to establish its efficacy and safety in neonates.
牛磺罗定锁，一种用于预防或治疗导管相关血流感染（CRBSI）的技术，在成人和儿科患者中有效，但在新生儿中很少描述。本描述性回顾性研究的目的是确定在足月和早产儿中预防性和治疗性牛磺罗定锁的可行性和直接结果。
我们在治疗组中实施了使用治疗性牛磺罗定锁，目的是在血管通路困难的危重新生儿中（第 1 组）通过保留导管来挽救抗生素治疗。此外，我们将牛磺罗定锁作为有发生 CRBSI 高风险的中心静脉导管（CVC）的新生儿的预防措施（第 2 组）。在治疗组中，每 24 小时（在治疗组中）注射 2%牛磺罗定溶液并锁定导管至少 120 分钟，直到感染清除（第 1 组）。在预防组中，每隔 48 小时锁定导管 30 分钟，直到 CVC 取出（第 2 组）。
这项研究共纳入 37 例接受牛磺罗定治疗的新生儿。我们没有观察到任何重大不良事件。在第 1 组（21 例）中，18 例（85.7%）在不取出导管的情况下实现了临床症状消失和菌血症清除；另外 3 例新生儿在开始锁定后不久就取出了导管，因为可以更换 CVC。在第 2 组（16 例）中，在导管放置期间未观察到 CRBSI。
在这项回顾性研究中，牛磺罗定成功地用于预防和治疗新生儿的 CRBSI，没有出现主要的不良影响。需要更大的队列和随机临床试验来确定其在新生儿中的疗效和安全性。
