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Kidney Week

Abstract: PO1354

NitriCap Hemodialysis Catheter Insert to Prevent Catheter-Related Bloodstream Infection

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Yevzlin, Alexander S., University of Michigan, Ann Arbor, Michigan, United States
  • Ramani, Karthik, University of Michigan, Ann Arbor, Michigan, United States
  • Kim, Maria, NOTA Labs, Ann Arbor, Michigan, United States
  • Doverspike, Joshua, University of Michigan, Ann Arbor, Michigan, United States
  • Suliman, Faroug, University of Michigan, Ann Arbor, Michigan, United States
  • Cornell, Marie, University of Michigan, Ann Arbor, Michigan, United States
  • Rojas-Pena, Alvaro, University of Michigan, Ann Arbor, Michigan, United States
Background

Tunneled dialysis catheters (TDCs) are associated with blood stream infections. We developed a novel nitric oxide (NO) eluting catheter insert and tested its effects in vitro and in sheep for two weeksto assess itsbacteriocidal activity.

Methods

Two cm long inserts using S-nitrosoglutathione (GSNO) as the NO donor and various other components were prepared and tested for their real-time NO release. In vitro studies were done to test the insert’s bactericidal effects in a real catheter hub antimicrobial model with S. aureus and P. aeuruginosa. NO releasing inserts (NitriCap) were compared to a control (without NO releasing). After 72 h of incubation at 24°C, the amount of viable bacteria in the fluid was quantified for each sample. Subsequently, the antimicrobial/anti-biofilm efficacy of NitriCap was tested in a 14-day ovine model of microbe rich natural environment and compared to controls (without NO).

Results

A formulation was devised with an initial burst of NO (>100 flux), followed by sustained NO flux for 72 h duration (>20 flux). This formulation lead to a 6.6 log reduction of S. aureus and 6.7 for P. aeruginosa using NitriCap compared to a control of no insert. The in vivo 14-day sheep studies showed a log reduction of 3.9 by Day 4 and 5.4 by the end of the study (Day 14) in the NitriCap group when compared to controls, (Fig. 1). After the 14 day sheep study was completed, the amount of bacteria/biofilm adhered to the inner lumen walls in four different regions of each catheter showed a 1.9 log reduction of bacteria even at the proximal tip for NitriCap vs. controls. Fluorescent microscopic images of bacteria/biofilm were taken of the inner lumen wall of each sample to qualitatively show the difference in bacterial/biofilm growth at four different regions of the catheter for NitriCap vs. control (Fig. 2).

Conclusion

This data strongly suggests that the NitriCap displays significant antimicrobial/anti-biofilm effects during in vitro and large animal in vivo studies, demonstrating that its implementation could minimize catheter related blood stream infections.