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Trisodium citrate 46.7% selectively and safely reduces staphylococcal catheter-related bacteraemia.

AbstractBACKGROUND:
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-lock(TM) (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.
AuthorsGeorgia Winnett, Jonathan Nolan, Michael Miller, Neil Ashman
JournalNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 23 Issue 11 Pg. 3592-8 (Nov 2008) ISSN: 1460-2385 [Electronic] England
PMID18503094 (Publication Type: Journal Article)
Chemical References
  • Anti-Infective Agents
  • Citrates
  • trisodium citrate
Topics
  • Aged
  • Anti-Infective Agents (adverse effects, therapeutic use)
  • Bacteremia (prevention & control)
  • Catheter-Related Infections (prevention & control)
  • Catheters, Indwelling (microbiology)
  • Citrates (adverse effects, therapeutic use)
  • Clinical Audit
  • Female
  • Humans
  • Kidney Diseases (therapy)
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Dialysis (instrumentation)
  • Staphylococcal Infections (prevention & control)
  • Staphylococcus aureus

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