Objectives and study To compare the incidence and characterise the type of catheter-related blood stream infections (CRBSIs) in children with intestinal failure on long-term home parenteral nutrition (PN), using heparin-saline based catheter locks versus those using taurolidine-based catheter locks. There is growing body of evidence that taurolidine-based catheter locks, which have a broad-spectrum antimicrobial and antifungal action, is associated with a decreased incidence of CRBSIs children on home PN.
Methods All children referred to a tertiary paediatric gastroenterology service with temporary or on-going intestinal failure requiring long-term PN or preparation for home PN between 2005–2011 were included. Children were given a single-bag system of PN with each infusion via central venous catheter. Parents were formally trained in aseptic techniques and to instil heparin-saline or taurolidine-based solution into the catheter after completion of each infusion. CRBSIs were defined as a laboratory-confirmed blood stream infection from with a peripheral or central venous sample. Results were excluded if evidence that the source of infection was from a second site. All cultures results were confirmed through the microbiology database and clinical records. Research ethics committee approval was sought, but ethical review was not deemed necessary.
Results 32 children (18 boys, 14 girls) were identified who required PN for intestinal failure for combined total of over 12,500 PN days. 9 children had no positive blood cultures. There were 126 positive blood cultures (27 organisms isolated) in the remaining 23 children. Of the 21 children who used a heparin-saline based catheter lock, 86% had one or more CRBSI. 11 children used a taurolidine-based catheter lock, with only 45% having one or more CRBSI.
Conclusion There was a significant reduction in the incidence of CRBSIs in those children using taurolidine-based catheter locks (TauroLock™) compared to heparin locks. There was an absolute risk reduction of 40.3% (95% CI 7.25 – 73.3%) with a numbers needed to treat (NNT) of 3 (95% CI 1.4–13.8). The use of taurolidine locks on all children on long-term home PN could reduce morbidity and morality, and have a significant impact on the associated costs of CRBSIs. Taurolidine-based catheter locks should be considered for all children on long-term PN.
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