Absence of microbial adaptation to taurolidine in patients on home parenteral nutrition who develop catheter related bloodstream infections and use taurolidine locks

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• 作者：E.D. Olthof^a ; ^{E.Olthof@mdl.umcn.nl} ; R.J. Rentenaar^b ; ^{R.Rentenaar@mmb.umcn.nl} ; A.J.M.M. Rijs^b ; ^{A.Rijs@mmb.umcn.nl} ; G.J.A. Wanten^a ; ^{G.Wanten@mdl.umcn.nl}
• 关键词：Home parenteral nutrition ; Bloodstream infection ; Taurolidine
• 刊名：Clinical Nutrition
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：32
• 期：4
• 页码：538-542
• 全文大小：426 K

文摘

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Summary

Background & aims

Some home parenteral nutrition (HPN) patients develop catheter related bloodstream infections (CRBSI) despite using an anti-microbial catheter lock solution taurolidine. The aim of this study was to assess whether long-term use of taurolidine leads to selective growth of microorganisms with increased taurolidine minimum inhibitory concentrations (MICs).

Methods

Bloodstream infections among 158 HPN patients with long-term taurolidine catheter locking were analyzed retrospectively. CRBSI-diagnosis was based on clinical symptoms, culture results, and absence of other sources of infections. CRBSIs were classified as definitive, probable or possible and exit site/tunnel/port or luminal infections. MICs were determined by broth microdilution.

Results

Between January 2009 and April 2011, 14 patients developed at least one luminal CRBSI episode during long-term taurolidine catheter locking (median (range) = 451 (78-1394) days). Coagulase-negative Staphylococcus species or Staphylococcus aureus predominated among CRBSI-causing Gram-positive bacteria. Taurolidine MICs were 512?mg/l or less in 50 % of these isolates (MIC₅₀). Taurolidine MIC₅₀ for Klebsiella pneumoniae and Escherichia coli, the most common CRBSI-causing Gram-negative bacteria, were 256 and 512?mg/l, respectively. Taurolidine MIC₅₀ among CRBSI-causing Candida albicans were 2048?mg/l.

Conclusion

Adaptation of microorganisms to taurolidine has not yet emerged as a factor in the pathogenesis of CRBSI in HPN patients with long-term taurolidine catheter locking.