Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: a systematic review and meta-analysis of randomized controlled trials
Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in critically ill patients, contributing to prolonged hospital stays and increased costs. Whether taurolidine lock solutions (TLS) are beneficial for the prevention of CRBSIs remains controversial. In...
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| description | Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in critically ill patients, contributing to prolonged hospital stays and increased costs. Whether taurolidine lock solutions (TLS) are beneficial for the prevention of CRBSIs remains controversial. In this meta-analysis, we aim to assess the efficacy of TLS for preventing CRBSIs.
We conducted a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials that reported on the effects of TLS for preventing CRBSIs. The primary outcome in these studies was catheter-related bloodstream infections, with microbial distribution of CRBSI and catheter-associated thrombosis as secondary outcomes. Data were combined using random-effects models owing to significant clinical heterogeneity.
Six randomized controlled trials (RCTs) conducted from 2004 through 2013 involving 431 patients and 86,078 catheter-days were included in the review. TLS were significantly associated with a lower incidence of CRBSIs when compared to heparin lock solutions (Risk Ratio [RR], 0.34; 95% Confidence Interval [CI], 0.21-0.55). Use of TLS significantly decreased the incidence of CRBSIs from gram-negative (G-) bacteria (P = 0.004; RR, 0.27; CI, 0.11-0.65), and was associated with a non-significant decrease in gram-positive (G+) bacterial infections (P = 0.07; RR, 0.41; CI, 0.15-1.09). No significant association was observed with TLS and catheter-associated thrombosis (RR, 1.99; CI, 0.75-5.28).
The use of TLS reduced the incidence of CRBSIs without obvious adverse effects or bacterial resistance. However, the susceptibility of G+ and G- bacteria to taurolidine and the risk for catheter-associated thrombosis of TLS are indeterminate due to limited data. The results should be treated with caution due to the limited sample sizes and methodological deficiencies of included studies. Therefore, additional well-designed and adequately powered RCTs are needed to confirm these findings. |
| doi_str_mv | 10.1371/journal.pone.0079417 |
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We conducted a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials that reported on the effects of TLS for preventing CRBSIs. The primary outcome in these studies was catheter-related bloodstream infections, with microbial distribution of CRBSI and catheter-associated thrombosis as secondary outcomes. Data were combined using random-effects models owing to significant clinical heterogeneity.
Six randomized controlled trials (RCTs) conducted from 2004 through 2013 involving 431 patients and 86,078 catheter-days were included in the review. TLS were significantly associated with a lower incidence of CRBSIs when compared to heparin lock solutions (Risk Ratio [RR], 0.34; 95% Confidence Interval [CI], 0.21-0.55). Use of TLS significantly decreased the incidence of CRBSIs from gram-negative (G-) bacteria (P = 0.004; RR, 0.27; CI, 0.11-0.65), and was associated with a non-significant decrease in gram-positive (G+) bacterial infections (P = 0.07; RR, 0.41; CI, 0.15-1.09). No significant association was observed with TLS and catheter-associated thrombosis (RR, 1.99; CI, 0.75-5.28).
The use of TLS reduced the incidence of CRBSIs without obvious adverse effects or bacterial resistance. However, the susceptibility of G+ and G- bacteria to taurolidine and the risk for catheter-associated thrombosis of TLS are indeterminate due to limited data. The results should be treated with caution due to the limited sample sizes and methodological deficiencies of included studies. Therefore, additional well-designed and adequately powered RCTs are needed to confirm these findings.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0079417</identifier><identifier>PMID: 24278133</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Anti-Infective Agents - therapeutic use ; Anticoagulants ; Bacteria ; Bacterial infections ; Catheter-Related Infections - microbiology ; Catheter-Related Infections - prevention & control ; Catheterization ; Catheters ; Clinical trials ; Confidence intervals ; Gram-Negative Bacteria - pathogenicity ; Gram-Positive Bacteria - pathogenicity ; Health aspects ; Health care costs ; Heparin ; Humans ; Incidence ; Infection ; Infections ; Medical instruments ; Medical research ; Meta-analysis ; Microbial drug resistance ; Microorganisms ; Morbidity ; Mortality ; Parenteral nutrition ; Patients ; Prevention ; Randomization ; Randomized Controlled Trials as Topic ; Systematic review ; Taurine - analogs & derivatives ; Taurine - therapeutic use ; Thiadiazines - therapeutic use ; Thromboembolism ; Thrombosis</subject><ispartof>PloS one, 2013-11, Vol.8 (11), p.e79417-e79417</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Liu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/3.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Liu et al 2013 Liu et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-82f14bf968ff56be44d7e9788fb579b6d32e816da31ba0534cf58bd9724f09af3</citedby><cites>FETCH-LOGICAL-c758t-82f14bf968ff56be44d7e9788fb579b6d32e816da31ba0534cf58bd9724f09af3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836857/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836857/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24278133$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Landoni, Giovanni</contributor><creatorcontrib>Liu, Yong</creatorcontrib><creatorcontrib>Zhang, An-Qiang</creatorcontrib><creatorcontrib>Cao, Lin</creatorcontrib><creatorcontrib>Xia, Hong-Tao</creatorcontrib><creatorcontrib>Ma, Jun-Jie</creatorcontrib><title>Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: a systematic review and meta-analysis of randomized controlled trials</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in critically ill patients, contributing to prolonged hospital stays and increased costs. Whether taurolidine lock solutions (TLS) are beneficial for the prevention of CRBSIs remains controversial. In this meta-analysis, we aim to assess the efficacy of TLS for preventing CRBSIs.
We conducted a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials that reported on the effects of TLS for preventing CRBSIs. The primary outcome in these studies was catheter-related bloodstream infections, with microbial distribution of CRBSI and catheter-associated thrombosis as secondary outcomes. Data were combined using random-effects models owing to significant clinical heterogeneity.
Six randomized controlled trials (RCTs) conducted from 2004 through 2013 involving 431 patients and 86,078 catheter-days were included in the review. TLS were significantly associated with a lower incidence of CRBSIs when compared to heparin lock solutions (Risk Ratio [RR], 0.34; 95% Confidence Interval [CI], 0.21-0.55). Use of TLS significantly decreased the incidence of CRBSIs from gram-negative (G-) bacteria (P = 0.004; RR, 0.27; CI, 0.11-0.65), and was associated with a non-significant decrease in gram-positive (G+) bacterial infections (P = 0.07; RR, 0.41; CI, 0.15-1.09). No significant association was observed with TLS and catheter-associated thrombosis (RR, 1.99; CI, 0.75-5.28).
The use of TLS reduced the incidence of CRBSIs without obvious adverse effects or bacterial resistance. However, the susceptibility of G+ and G- bacteria to taurolidine and the risk for catheter-associated thrombosis of TLS are indeterminate due to limited data. The results should be treated with caution due to the limited sample sizes and methodological deficiencies of included studies. Therefore, additional well-designed and adequately powered RCTs are needed to confirm these findings.</description><subject>Anti-Infective Agents - therapeutic use</subject><subject>Anticoagulants</subject><subject>Bacteria</subject><subject>Bacterial infections</subject><subject>Catheter-Related Infections - microbiology</subject><subject>Catheter-Related Infections - prevention & control</subject><subject>Catheterization</subject><subject>Catheters</subject><subject>Clinical trials</subject><subject>Confidence intervals</subject><subject>Gram-Negative Bacteria - pathogenicity</subject><subject>Gram-Positive Bacteria - pathogenicity</subject><subject>Health aspects</subject><subject>Health care costs</subject><subject>Heparin</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infection</subject><subject>Infections</subject><subject>Medical instruments</subject><subject>Medical research</subject><subject>Meta-analysis</subject><subject>Microbial drug resistance</subject><subject>Microorganisms</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Parenteral nutrition</subject><subject>Patients</subject><subject>Prevention</subject><subject>Randomization</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Systematic review</subject><subject>Taurine - analogs & derivatives</subject><subject>Taurine - therapeutic use</subject><subject>Thiadiazines - therapeutic use</subject><subject>Thromboembolism</subject><subject>Thrombosis</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk1uL1DAUx4so7jr6DUQDguhDx6Zpm9QHYVm8DCws6OprSJOTmaxpMybp6vhl_KpmLjvMyD5IHxJOf-efc82yp7iYYkLxm2s3-kHY6dINMC0K2laY3stOcUvKvCkLcv_gfpI9CuG6KGrCmuZhdlJWJWWYkNPsz5UYvbNGmQGQdfI7Cs6O0bghIO08igtASw83MKxtyGkkRbJF8LkHKyIo1FnnVIgeRI_MoEFuvN8igcIqROhFNBIlCQM_kRgU6iGKXKTQV8GEtaJPVteb30lLuiGmcGy6Rm-EDY-zBzod8GR3TrKvH95fnX_KLy4_zs7PLnJJaxZzVmpcdbptmNZ100FVKQotZUx3NW27RpESGG6UILgTqQyV1DXrVEvLShet0GSSPd_qLq0LfFfbwHHVFHVR0ZomYrYllBPXfOlNL_yKO2H4xuD8nAufUrXAmSpVByUmXZH0MWWFYkJ1EpjsMMgmab3bvTZ2PSiZquuFPRI9_jOYBZ-7G04YadgmmFc7Ae9-jBAi702QYK0YwI2buEvM6jZNwCR78Q96d3Y7ai5SAqmNLr0r16L8rEqzQkuM60RN76DSp6A3qXegTbIfObw-clj3F37FuRhD4LMvn_-fvfx2zL48YBcgbFzsB_cYrLag9C4ED3pfZFzw9R7dVoOv94jv9ii5PTts0N7pdnHIX8zuHSI</recordid><startdate>20131121</startdate><enddate>20131121</enddate><creator>Liu, Yong</creator><creator>Zhang, An-Qiang</creator><creator>Cao, Lin</creator><creator>Xia, Hong-Tao</creator><creator>Ma, Jun-Jie</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20131121</creationdate><title>Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: a systematic review and meta-analysis of randomized controlled trials</title><author>Liu, Yong ; Zhang, An-Qiang ; Cao, Lin ; Xia, Hong-Tao ; Ma, Jun-Jie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-82f14bf968ff56be44d7e9788fb579b6d32e816da31ba0534cf58bd9724f09af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Anti-Infective Agents - therapeutic use</topic><topic>Anticoagulants</topic><topic>Bacteria</topic><topic>Bacterial infections</topic><topic>Catheter-Related Infections - microbiology</topic><topic>Catheter-Related Infections - prevention & control</topic><topic>Catheterization</topic><topic>Catheters</topic><topic>Clinical trials</topic><topic>Confidence intervals</topic><topic>Gram-Negative Bacteria - pathogenicity</topic><topic>Gram-Positive Bacteria - pathogenicity</topic><topic>Health aspects</topic><topic>Health care costs</topic><topic>Heparin</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infection</topic><topic>Infections</topic><topic>Medical instruments</topic><topic>Medical research</topic><topic>Meta-analysis</topic><topic>Microbial drug resistance</topic><topic>Microorganisms</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Parenteral nutrition</topic><topic>Patients</topic><topic>Prevention</topic><topic>Randomization</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Systematic review</topic><topic>Taurine - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Yong</au><au>Zhang, An-Qiang</au><au>Cao, Lin</au><au>Xia, Hong-Tao</au><au>Ma, Jun-Jie</au><au>Landoni, Giovanni</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: a systematic review and meta-analysis of randomized controlled trials</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-11-21</date><risdate>2013</risdate><volume>8</volume><issue>11</issue><spage>e79417</spage><epage>e79417</epage><pages>e79417-e79417</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in critically ill patients, contributing to prolonged hospital stays and increased costs. Whether taurolidine lock solutions (TLS) are beneficial for the prevention of CRBSIs remains controversial. In this meta-analysis, we aim to assess the efficacy of TLS for preventing CRBSIs.
We conducted a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials that reported on the effects of TLS for preventing CRBSIs. The primary outcome in these studies was catheter-related bloodstream infections, with microbial distribution of CRBSI and catheter-associated thrombosis as secondary outcomes. Data were combined using random-effects models owing to significant clinical heterogeneity.
Six randomized controlled trials (RCTs) conducted from 2004 through 2013 involving 431 patients and 86,078 catheter-days were included in the review. TLS were significantly associated with a lower incidence of CRBSIs when compared to heparin lock solutions (Risk Ratio [RR], 0.34; 95% Confidence Interval [CI], 0.21-0.55). Use of TLS significantly decreased the incidence of CRBSIs from gram-negative (G-) bacteria (P = 0.004; RR, 0.27; CI, 0.11-0.65), and was associated with a non-significant decrease in gram-positive (G+) bacterial infections (P = 0.07; RR, 0.41; CI, 0.15-1.09). No significant association was observed with TLS and catheter-associated thrombosis (RR, 1.99; CI, 0.75-5.28).
The use of TLS reduced the incidence of CRBSIs without obvious adverse effects or bacterial resistance. However, the susceptibility of G+ and G- bacteria to taurolidine and the risk for catheter-associated thrombosis of TLS are indeterminate due to limited data. The results should be treated with caution due to the limited sample sizes and methodological deficiencies of included studies. Therefore, additional well-designed and adequately powered RCTs are needed to confirm these findings.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24278133</pmid><doi>10.1371/journal.pone.0079417</doi><tpages>e79417</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2013-11, Vol.8 (11), p.e79417-e79417 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1460504757 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Anti-Infective Agents - therapeutic use Anticoagulants Bacteria Bacterial infections Catheter-Related Infections - microbiology Catheter-Related Infections - prevention & control Catheterization Catheters Clinical trials Confidence intervals Gram-Negative Bacteria - pathogenicity Gram-Positive Bacteria - pathogenicity Health aspects Health care costs Heparin Humans Incidence Infection Infections Medical instruments Medical research Meta-analysis Microbial drug resistance Microorganisms Morbidity Mortality Parenteral nutrition Patients Prevention Randomization Randomized Controlled Trials as Topic Systematic review Taurine - analogs & derivatives Taurine - therapeutic use Thiadiazines - therapeutic use Thromboembolism Thrombosis |
| title | Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: a systematic review and meta-analysis of randomized controlled trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T06%3A37%3A53IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Taurolidine%20lock%20solutions%20for%20the%20prevention%20of%20catheter-related%20bloodstream%20infections:%20a%20systematic%20review%20and%20meta-analysis%20of%20randomized%20controlled%20trials&rft.jtitle=PloS%20one&rft.au=Liu,%20Yong&rft.date=2013-11-21&rft.volume=8&rft.issue=11&rft.spage=e79417&rft.epage=e79417&rft.pages=e79417-e79417&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0079417&rft_dat=%3Cgale_plos_%3EA478172115%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1460504757&rft_id=info:pmid/24278133&rft_galeid=A478172115&rft_doaj_id=oai_doaj_org_article_8d2dbe213b024f1780d8adbce8cb1ec6&rfr_iscdi=true |