Central venous catheters and catheter locks in children with cancer: a prospective randomized trial of taurolidine versus heparin

Central venous catheters (CVC) are an inevitable part of thetreatment of children with cancer. Although many attempts havebeen made to reduce the risk of catheter-related infections, CVCsremain a major risk factor of bloodstream infections [1–4]. Stud-ies have shown that biofilm develops quickly once a CVC isinserted into a patient [5]. Bacteria living in a biofilm can bevery difficult to eradicate and are likely to be involved in casesof recurrent CRBSI [5,6].Heparin is often used to lock the catheter to prevent clottingwhen the catheter is not in use although heparin may enhance thegrowth of bacteria and the biofilm formation [7]. A Cochranereview has found prophylactic antibiotic catheter-lock to be ben-eficial in preventing CRBSI, but it is not routinely recommendeddue to the risk of selecting resistant microorganisms [8,9].Taurolidine is derived from the naturally occurring amino-sulphonic acid taurinamide and formaldehyde [10]. Taurolidineand its active metabolites contain an activeN-methylol groupthat cross-links with the protein part of the bacterial cell walland thereby neutralizes endotoxins and probably also to someextent exotoxins [11,12]. Taurolidine has also been reported tohave anti-adherence properties [13] and may reduce biofilmformation [14–16]. The substance has shown a broad spectrumof antimicrobial activity against both gram-positive and gram-negative bacteria as well as fungi. Taurolidine used as a cathe-ter-lock has shown efficacy in preventing CRBSI in adultpatients [17,18]. One non-randomized study of the use oftaurolidine as a catheter-lock in children with cancer reducedthe rate of gram-positive bloodstream infections [19]. Nointrinsic microbial resistance towards taurolidine has beenreported [20].We report the result of a prospective, randomized, controlledopen-label study in which CVCs locked with a taurolidine solu-tion were compared to CVCs locked with a standard heparinsolution.