NDT Advance Access originally published online on May 25, 2008
Nephrology Dialysis Transplantation 2008 23(11):3592-3598; doi:10.1093/ndt/gfn299
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Trisodium citrate 46.7% selectively and safely reduces staphylococcal catheter-related bacteraemia
1 Renal Unit 2 Department of Infection, St Bartholomew's and the Royal London Hospitals, London, E1 1BB, UK
Correspondence and offprint requests to: Neil Ashman, Renal Dialysis and Transport OPD, Renal and Cardiac Directorate, The Royal London Hospital, Basement, West Wing, Whitechapel, London, E1B 1BB, UK. Tel: +44-20-7377-7480; Fax: +44-20-7377-7003; E-mail: neil.ashman{at}bartsandthelondon.nhs.uk
 |
Abstract |
|---|
Background. Trisodium citrate (TSC) 30% has been shown in a randomized control trial to be an effective antimicrobial catheter locking solution, able to significantly reduce catheter-related bacteraemia (CRB) in haemodialysis patients. Since that report, the formulation in Europe has been changed to 46.7% TSC without confirmatory data on efficacy. We report a 55 915 patient-day at risk experience in tunnelled lines of 46.7% TSC, emphasizing efficacy and changes in microbiology seen.
Methods. On 1 July 2006, inter-dialytic catheter locking solution was changed from 5000 IU/ml heparin to Citra-lockTM (46.7% TSC) in all haemodialysis patients at Barts and the London Renal Unit dialysing through an incident or prevalent tunnelled catheter. Prospectively collected blood culture data for the 6 months prior to the switch and 3 months at the end of the first year of TSC use were analysed. TSC tolerability was excellent with only a single withdrawal for intolerance of the agent. No major adverse events were reported.
Results. A major fall in CRB rates was noticed with a change from heparin (2.13/1000 catheter-days) in 2006 to TSC (0.81/1000 catheter-days) in 2007. This was due to significant reductions in staphylococcal CRB, true for sensitive, methicillin-resistant and coagulase-negative staphylococci. No increase in catheter malfunction was observed.
Conclusions. We found that 46.7% TSC is a safe, convenient and highly effective catheter locking solution, leading to significant reduction in CRB largely by preventing staphylococcal bloodstream infections. Given that Staphylococcus aureus in particular is associated with serious and often disseminated infection, TSC seems to be a powerful tool for dialysis units.
Keywords: antibiotic locking solutions; catheter-related bacteraemia; Staphylococcus aureus
Received for publication: 6. 3.08
Accepted in revised form: 5. 5.08
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H.-D. Polaschegg and K. Sodemann Safety of concentrated trisodium citrate catheter locks Nephrol. Dial. Transplant., December 1, 2008; 23(12): 4075 - 4075. [Full Text] [PDF]
|
|