In vitro comparison of efficacy of catheter locks in the treatment of catheter related blood stream infection

Background & aims: Venous access used for parenteral nutrition (PN) application is extremely important for patients with intestinal failure. Potential loss of venous access might be a catastrophy for the patient. Catheter infections are a serious complication of PN application. Systemic administration of antibiotics as well as local antibiotic locks into the catheter to sterilize the catheter are used to treat catheter infections. However, there is no clear recommendation applying use of antibiotic locks, that would specify the type and concentration of antimicrobial medication. Our objective were to compare the efficacy of different types of antimicrobial lock therapy (especially taurolidine) and their concentrations to eradicate infectious agents. Methods: Bacterial strains of microorganisms (Staphylococcus epidermidis, Staphylococcus aureus, methicillin resistant S. aureus (MRSA), Pseudomonas aeruginosa, multidrug-resistant P. aeruginosa, Candida albicans) were used. Subsequently, the catheter was exposed to the microbes and then was incubated with a specific lock for 2 or 24 h at 37 degrees C. We used these locks: ethanol 70%, taurolidine, gentamicine in concentrations 0,5, 1 and 10 mg/ml and vancomycine in concentrations 1, 5, and 10 mg/ml. The number of remaining CFU (colony forming units) was compared after incubation. Results: 70% ethanol and taurolidine were most effective for all studied microorganisms. Gentamicine was more effective than vancomycine. Conclusions: The most effective antimicrobial lock solutions to eradicate selected pathogenic agents were ethanol and taurolidine. Use of antibiotics is often effective after many hours of treatment and there is a risk of inadequate therapy. (C) 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.