Abstract: FR-OR047

Locking Solutions Impact on Biofilm Formation in Tunneled Hemodialysis Catheters (T-HDC) and Activation of the Inflammatory Response

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Author

  • Jimenez Hernandez, Mario, Hospital Clinic of Barcelona, BARCELONA, BARCELONA, Spain
Background

The surface of the T-HDC proves an optimal environment for the development of bacterial biofilm. The presence of these biofilms facilitates the generation of catheter-related infections (CRI) and possibly thrombosis, which can significantly reduce catheter life as well as its relationship with higher inflammatory state. Use locking solutions into catheter with antibacterial and anticoagulant activity seems reduced those complications. To date, there are no studies comparing locking solutions and biofilm formation on catheter surface and their possible relation with inflammatory response.

Methods

Objetive: To analyze biofilm formation into THDC locked with heparin solution 10%, citrate 4% or taurolidine + heparin 500UI + citrate al 4% mix solution through confocal microscopy and activation of the inflammatory response
Prospective study, 35 patients in HD were included in whom the catheter was removed for non–infection-related reasons, according to the lock solution used in T-HDC were divided in three groups: 1) heparin 1:1000, 2) citrate 4% and 3) taurolidine+citrate 4%+heparin 500UI. Microbiological growth were determined in each catheter. C- reactive protein, IL-6, IL-10 and Tumoral Necrosis Factor alfa were determined. We use confocal microscopy to determine the characteristics of biofilm.

Results

35 patients were included, mean age was 67.06±4.41 y.o, 80% were male sex; no significant differences were found related with clinical and demographical variables. Both catheters and blood cultures were negative. Catheter locking with taurolidine had lower thickness of biofilm compared with citrate 4% and heparin (28.85±6.86 vs 49.99 ±16.56 vs 56.2 ±15.67mm; p<0.001) respectively, as well as volume of biofilm (1013967.2 ±1184812.3 vs 3706378,3 ±2152223,8 vs 5553246,791 ±2448121,8 mm3; p<0.001). No significant differences were found in the inflammatory markers studied among the 3 locking solutions

Conclusion

The presence of biofilm was found in all catheters, even in the absence of bacteremia and regardless of the type of locking solution used, however, biofilm was thiner in those catheters locked with the taurolodine-based solution which could be related with better outcome and lower bacteremia rates. No statistical differences were found in inflammatory response between citrate 4% años taurolidine based solution.

Funding

  • Private Foundation Support