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

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 32; no. 4; pp. 538 - 542
• Main Authors: Olthof, E.D, Rentenaar, R.J, Rijs, A.J.M.M, Wanten, G.J.A
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.08.2013; Elsevier
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; blood flow; Bloodstream infection; Candida albicans; Candida albicans - drug effects; Catheter-Related Infections - diagnosis; Catheter-Related Infections - etiology; Catheter-Related Infections - microbiology; coagulase negative staphylococci; Drug Resistance, Microbial; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Escherichia coli; Escherichia coli - drug effects; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Gram-negative bacteria; Gram-positive bacteria; Home parenteral nutrition; Human bacterial diseases; Humans; Infectious diseases; Intensive care medicine; Klebsiella pneumoniae; Klebsiella pneumoniae - drug effects; Male; Medical sciences; microbial growth; Microbial Sensitivity Tests; Middle Aged; minimum inhibitory concentration; parenteral feeding; Parenteral Nutrition, Home - adverse effects; pathogenesis; patients; Retrospective Studies; Staphylococcus - drug effects; Staphylococcus aureus; Staphylococcus aureus - drug effects; Taurine - analogs & derivatives; Taurine - pharmacology; Taurolidine; Thiadiazines - pharmacology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Young Adult; Bloodstream infection; EUCAST; European Committee on Antimicrobial Susceptibility Testing; MIC; HPN; CAMHB; Home parenteral nutrition; catheter related bloodstream infections; minimum inhibitory concentration; bloodstream infections; cation-supplemented mueller hinton broth; PAC; port a cath; BSI; RPMI; MIC50; minimum inhibitory concentration required to inhibit the growth of 50% of these isolates; Taurolidine; CRBSI; Roswell Park Memorial Institute; Human; Infection; Use; Bacteriosis; Metabolic diseases; Parenteral nutrition; Antiinfectious; Bacteremia; Parenteral administration; Adaptation; WHO
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2012.11.014

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.