A randomized double-blind controlled trial of taurolidine-citrate catheter locks for the prevention of bacteremia in patients treated with hemodialysis

Am J Kidney Dis. 2010 Jun;55(6):1060-8. doi: 10.1053/j.ajkd.2009.11.025. Epub 2010 Mar 6.


Background: Bacteremia is a major cause of morbidity in patients using intravascular catheters. Interdialytic locking with antibiotics decreases the incidence of bacteremia, but risks antibiotic resistance. Taurolidine is a nontoxic broad-spectrum antimicrobial agent that has not been associated with resistance. Preliminary evidence suggests that taurolidine-citrate locks decrease bacteremia, but cause flow problems in established catheters.

Study design: Double-blind randomized controlled trial.

Intervention: Interdialytic locking with taurolidine and citrate (1.35% taurolidine and 4% citrate) compared with heparin (5,000 U/mL) started at catheter insertion.

Setting & participants: 110 adult hemodialysis patients with tunneled cuffed intravascular catheters inserted at 3 centers in Northwest England.

Outcomes & measurements: Primary end points were time to first bacteremia episode from any cause and time to first use of thrombolytic therapy.

Results: There were 11 bacteremic episodes in the taurolidine-citrate group and 23 in the heparin group (1.4 and 2.4 episodes/1,000 patient-days, respectively; P = 0.1). There was no significant benefit of taurolidine-citrate versus heparin for time to first bacteremia (hazard ratio, 0.66; 95% CI, 0.2-1.6: P = 0.4). Taurolidine-citrate was associated with fewer infections caused by Gram-negative organisms than heparin (0.2 vs 1.1 infections/1,000 patient-days; P = 0.02); however, there was no difference for Gram-positive organisms (1.1 vs 1.2 infections/1,000 patient-days; P = 0.8). There was a greater need for thrombolytic therapy in the taurolidine-citrate versus heparin group (hazard ratio, 2.5; 95% CI, 1.3-5.2; P = 0.008).

Limitations: Small sample size. The study included bacteremia from all causes and was not specific for catheter-related bacteremia.

Conclusions: Taurolidine-citrate use did not decrease all-cause bacteremia and was associated with a greater need for thrombolytic treatment. There was a decrease in infections caused by Gram-negative organisms and a trend to a lower frequency of bacteremia, which warrants further study.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Infective Agents / therapeutic use
  • Anticoagulants / therapeutic use
  • Bacteremia / epidemiology
  • Bacteremia / etiology*
  • Bacteremia / prevention & control*
  • Catheters, Indwelling / microbiology*
  • Citric Acid / therapeutic use*
  • Double-Blind Method
  • Female
  • Gram-Positive Bacterial Infections / epidemiology
  • Gram-Positive Bacterial Infections / etiology
  • Gram-Positive Bacterial Infections / prevention & control
  • Heparin / therapeutic use
  • Humans
  • Incidence
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Renal Dialysis / adverse effects*
  • Renal Dialysis / instrumentation
  • Renal Dialysis / methods
  • Taurine / analogs & derivatives*
  • Taurine / therapeutic use
  • Thiadiazines / therapeutic use*


  • Anti-Infective Agents
  • Anticoagulants
  • Thiadiazines
  • Taurine
  • Citric Acid
  • taurolidine
  • Heparin

Associated data

  • ISRCTN/ISRCTN51902376