G Ital Nefrol. 2026 Jun 30;43(3):2026-vol3. doi: 10.69097/43-03-2026-02.
ABSTRACT
Background. Catheter-related bloodstream infections (CRBSIs) and thrombosis are the most severe complications associated with central venous catheters (CVCs) in hemodialysis. Taurolidine, a non-antibiotic lock solution with broad antimicrobial and anti-biofilm activity, is a practical option for prevention. Aim. To evaluate, in a real-life cohort, the impact of Taurolidine-based lock solutions on the prevention of CRBSIs and thrombosis in hemodialysis CVCs, and to explore implications for future protocols. Methods. A single-center, retrospective observational study was conducted between January 2023 and August 2025 in the Hemodialysis Unit of Crema Hospital. Seventy-nine patients were included (61 tunneled and 18 temporary CVCs). Data were extracted from electronic medical records and chart reviews. Lock regimens: Taurolidine + Heparin (T/H) routinely used; Taurolidine + Urokinase (T/U) mainly used on an as-needed basis in complex cases; dwell time 48-72 hours according to dialysis interval. Outcomes included CRBSIs, thrombosis, and event-free survival (Kaplan-Meier). Results. A total of 25 CRBSIs (31.6% overall; 41% among tunneled CVCs) and 11 thromboses (13.9% overall; 18% among tunneled CVCs) were recorded, all occurring in tunneled catheters. No de novo events were observed in temporary CVCs. No complications occurred with T/H, whereas events clustered in the T/U group, composed of clinically complex patients with recurrent malfunction. Kaplan-Meier analysis, performed for descriptive purposes, showed a more favorable event-free survival pattern in the T/H group compared with T/U and heparin alone. Conclusions. In our experience, Taurolidine/Heparin was associated with a favorable efficacy and safety profile in preventing CRBSIs and thrombosis in tunneled CVCs. A scheduled use of Taurolidine/Urokinase may provide additional benefit in patients at high thrombotic risk. Prospective multicenter studies and standardized protocols are warranted. The establishment of dedicated AV-teams and registries could also improve organization of care.
PMID:42423054 | DOI:10.69097/43-03-2026-02