TauroSept

Catheter-related bloodstream infections (CRBSI)

CRBSIs (catheter-related bloodstream infections) continue to be associated with considerable morbidity and mortality and cause high treatment costs. Optimal avoidance of infection and infection control are an absolute necessity when dealing with central vascular access devices (CVADs). Nevertheless, the incidence of CRBSI in Europe is 2 – 4.6 per 1000 catheter days despite the most varied preventive measures and the mortality of CRBSI is still between 5 and 25 %. _{(14, 15, 21)} The risk of CRBSI increases steadily depending on the duration of catheterisation.

The benefits of Geistlich TauroSept®

The best prevention against the development of CRBSIs is observation of strict hygiene guidelines when inserting and manipulating a CVAD. In addition, the instillation of antimicrobial solutions like Geistlich TauroSept® into the device lumen (antimicrobial lock) has been shown to be clinically effective. _{(1, 8, 10, 17, 20)}

Geistlich TauroSept® is intended for instillation in CVADs between treatments in order to prevent bacterial and fungal growth leading to microbial infection in the CVAD lumen as well as to maintain device patency and avoid staphylocoagulase-mediated coagulation.

Characteristics

Prevention of catheter infections

• Broad bactericidal and fungicidal spectrum ₍₂₂₎
• Effective against antibiotic-resistant bacteria ₍₂₃₎
• No development of bacterial resistance known ₍₁₆₎

Treatment of infected catheters

• Resolves the catheter biofilm _(12,24)
• Detoxifies endo- and exotoxins ₍₂₎

Prevention of catheter thrombosis

• Inhibits blood coagulation factors ₍₂₅₎
• Prevents surface activiation of platelets ₍₁₉₎
• Inhibits staphylocoagulase activity ₍₂₆₎

Excellent tolerance

• Can be flushed ₍₇₎
• Rapidly metabolized to Taurine, H₂O and CO₂ ₍₂₇₎

Guidelines

• European nephrology guidelines ERBP (European Renal Best Practice), 2010
  "Preventive use of antimicrobial lock is desirable to reduce the rate of CRBSI.” ₍₂₈₎
• ESPEN guidelines on chronic intestinal failure in adults, 2016
  “We suggest that catheter locking with taurolidine may be used to prevent central venous catheter related infections.” ₍₂₉₎
• GAVeCeLT consensus. J Vasc Access 2016
  “ The drugs most likely to be used as antibacterial locks are taurolidine and citrate, which have optimal characteristics in terms of safety, efficacy and cost effectiveness.” ₍₃₀₎

Presentation and package sizes

Each original pack contains 5 glass vials containing 6 ml or 10 ml of Geistlich TauroSept®. The product is sterile. Opened Geistlich TauroSept® vials can be stored for 48 hours and multiple withdrawal is possible. The content of a vial is for a single patient only and must be used within 48 hours after the first puncture.

References

1 Bisseling, T. M., M. C. Willems, et al. (2010). “Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: a heparin controlled prospective trial.” Clin Nutr 29(4): 464–8.
2 Blenkharn, J. I. (1988). “Sustained anti-adherence activity of taurolidine (Taurolin) and noxythiolin (Noxyflex S) solutions.” J Pharm Pharmacol 40(7): 509–11.
3 Blenkharn, J. I. (1987). “The antibacterial and anti-endotoxin activity of taurolidine in combination with antibiotics.” Surg Res Comm 2: 149–155.
4 Bouza, E., R. San Juan, et al. (2004). “A European perspective on intravascular catheter-related infections: report on the microbiology workload, aetiology and antimicrobial susceptibility (ESGNI-005 Study).” Clin Microbiol Infect 10(9): 838–42.
5 Donlan, R. M., Costerton J. W. (2002). “Biofilms: Survival mechanisms of clinically relevant microorganisms.” CMR.15.2.167–193.
6 Gorman, S. P., D. F. McCafferty, et al. (1987). “Reduced adherence of micro-organisms to human mucosal epithelial cells following treatment with Taurolin, a novel antimicrobial agent.” J Appl Bacteriol 62(4): 315–20.
7 Gong, L., H. E. Greenberg, et al. (2007). “The pharmacokinetics of taurolidine metabolites in healthy volunteers.” J Clin Pharmacol 47(6): 697–703.
8 Jonkers, C., K. I. Looman, et al. (2012). “Incidence of central venous catheter related bloodstream infections in adults and children on home parenteral nutrition: heparin versus taurolidine catheter lock “ Clinical Nutrition Supplements 7(1): 203–204.
9 Jurewitsch, B., T. Lee, et al. (1998). “Taurolidine 2 % as an antimicrobial lock solution for prevention of recurrent catheter-related bloodstream infections.” JPEN J Parenter Enteral Nutr 22(4): 242–4.
10 Jurewitsch, B. and K. N. Jeejeebhoy (2005). “Taurolidine lock: the key to prevention of recurrent catheter-related bloodstream infections.” Clin Nutr 24(3): 462–5.
11 Knight, B. I., G. G. Skellern, et al. (1981). “The characterisation and quantitation by high-performance liquid chromatography of the metabolites of taurolin.” Br J Clin Pharmacol 12 (3):439–40.
12 Koldehoff, M. and J. L. Zakrzewski (2004). “Taurolidine is effective in the treatment of central venous catheter-related bloodstream infections in cancer patients.” Int J Antimicrob Agents 24(5): 491–5.
13 Hulshof, E. C., Hanff, L.M. et al. (2017). “Taurolidine in Pediatric Home Parenteral Nutrition Patients.” Pediatr Infect Dis J. 36: 233–235.
14 Mermel, L. A. (2001). “New technologies to prevent intravascular catheter-related bloodstream infections.” Emerg Infect Dis 7(2): 197–9.
15 Munoz, P., E. Bouza, et al. (2004). “Clinical-epidemiological characteristics and outcome of patients with catheter-related bloodstream infections in Europe (ESGNI-006 Study).” Clin Microbiol Infect 10(9): 843-5.
16 Olthof, E. D., R. J. Rentenaar, et al. (2013). “Absence of microbial adaptation to taurolidine in patients on home parenteral nutrition who develop catheter related bloodstream infections and use taurolidine locks.” Clin Nutr 32 (4): 538–42.
17 Olthof, E. D., M. W. Versleijen, et al. (2014). “Taurolidine Lock Is Superior to Heparin Lock in the Prevention of Catheter Related Bloodstream Infections and Occlusions.” PLoS One 9 (11): e111216.
18 Olthof, E. D., R. Nijland, et al. (2015). “Microbiocidal effects of various taurolidine containing catheter lock solutions.” Clin Nutr 34 (2): 309–14.
19 Reinmuller, J. (1999). “[The influence of taurolidine on physiological and pathological blood coagulation and implications for its use].” Zentralbl Chir 124 Suppl 4: 13–8.
20 Sherertz, R. J., M. S. Boger, et al. (2006). “Comparative in vitro efficacies of various catheter lock solutions.” Antimicrob Agents Chemother 50(5): 1865–8.
21 Tacconelli, E., G. Smith, et al. (2009). “Epidemiology, medical outcomes and costs of catheter related bloodstream infections in intensive care units of four European countries: literature and registry-based estimates.” J Hosp Infect 72(2): 97–103.
22 Torres-Viera, C., C. Thauvin-Eliopoulos, et al. (2000). “Activities of taurolidine in vitro and in experimental enterococcal endocarditis.” Antimicrob Agents Chemother 44(6): 1720-4.
23 Traub, W. H., B. Leonhard, et al. (1993). “Taurolidine: in vitro activity against multiple-antibioticresistant, nosocomially significant clinical isolates of Staphylococcus aureus, Enterococcus faecium, and diverse Enterobacteriaceae.” Chemotherapy 39(5): 322–30.
24 Weber, M., F. Meyer, et al. (2009). “[Spectrum of indications and perioperative management in i. v. port-a-cath explantation-alternative administration of taurolin in case of i. v. port-a-cath infection].” Zentralbl Chir 134(4): 350–6.
25 Kaptanoglu L et al. Eur J of Physiol 2008. 578:238–41.
26 Reinmüller J et al. Hämostaseologie 1999. 19:94–7.
27 Steinbach-Lebbin C et al. Drug. Res. 1982. 32(12):1542–1546.
28 Vanholder R et al. NDT Plus. 2010. 3:234–246. 18
29  Pironi L et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr. 2016. 35 (2):247–307.
30 Pittiruti M et al. J Vasc Access. 2016. 17 (6):453–464.