Taurolidine 2% Catheter Locking to Prevent Catheter-related Bloodstream Infections in Patients on Home Parenteral Nutrition With a High Infection Risk and Those With a New Central Venous Access Device
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Enrollment
- 105
- Locations
- 14
- Primary Endpoint
- Mean number of catheter related blood stream infections CRBSI/1'000 catheter days in each group
Study Overview
Brief Summary
The purpose of this study is to determine if TauroSept® taurolidine 2% is more efficient than saline solution 0.9% as a catheter lock solution in preventing catheter related blood stream infections in patients with home parenteral nutrition.
Detailed Description
Home Parenteral Nutrition has become a mainstay in the support of patients with chronic intestinal failure. It requires the presence of a central venous catheter to assure adequate venous access. Catheter Related BloodStream Infections (CRBSIs) are frequent. Most CRBSIs originate from contamination of the catheter hub and subsequent growth of microorganisms embedded within the biofilm that rapidly develops on the inner catheter surface. The best preventive measure against the development of CRBSIs is observation of strict hygiene guidelines when inserting and manipulating a central venous catheter and in addition to this the instillation of antimicrobial solutions like TauroSept® or saline solution 0.9% into the catheter lumen (antimicrobial lock). This measure is currently widely used in clinical practice.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Eligibility Criteria
- Ages
- 18 Years to 80 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Benign underlying disease leading to long-term intestinal failure who will receive HPN and/or fluids (saline and/or glucose) at least 2 times /week over a subcutaneously tunnelled single-lumen Central Venous Catheter (CVC) (Hickman/Broviac or subcutaneous port) for at least one year
- •Patient receives a new single lumen central vascular access device for HPN (new patient starting HPN or patient already on HPN) allocation to Group I = new catheter group] or
- •Patient is already on HPN for ≥1 year prior to trial inclusion and has a CRBSI rate (bacterial and/or yeast infections) of >0.3/year and a catheter that has been in place for ≥6 months (allocation to Group II = high risk group). (Previous salvage of this catheter by line-lock antibiotics or other therapeutic interventions is not an exclusion criterion as long as this has been performed at least two months before enrolment in the trial)
- •Estimated life expectancy ≥1 year
- •Male or female patient aged 18 - 80 years
- •Patient is fully able to understand the nature of the proposed intervention and gives written informed consent before entering the trial.
Exclusion Criteria
- •cannot be expected to comply with the trial plan (substance abuse, mental condition)
- •has significant cardiovascular disease such as unstable angina, acute myocardial infarction or recent cerebral vascular accident (within 6 weeks); a cardiac rhythm which in the investigators judgment may result in significant hemodynamic effects
- •has a known hypersensitivity/allergy to taurolidine 2% or saline solution 0.9% and/or their excipients.
- •is pregnant, lactating, or nursing.
- •has a current bloodstream infection
- •has any clinically significant abnormalities in blood coagulation requiring intervention
- •has received thrombolytic therapy in the 6 weeks prior to insertion (aspirin 80-325 mg daily is acceptable).
- •has received an investigational drug within 30 days of trial entry
- •has an antibiotic coated, silver impregnated or antimicrobial cuff catheter
- •has received a Taurolidine lock previously
- •has compromised skin integrity, including any infection at the insertion site
- •has received parenteral or oral antibiotic therapy <2months prior trial inclusion
Outcomes
Primary Outcomes
Mean number of catheter related blood stream infections CRBSI/1'000 catheter days in each group
Time Frame: 12 months
Secondary Outcomes
- Median time to a catheter related blood stream infection CRBSI per patient per group(12 months)
Investigators
Geert Wanten
MD, PhD, MSc
Radboud University Medical Center