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Central Venous Catheter Complications
Published in John K. DiBaise, Carol Rees Parrish, Jon S. Thompson, Short Bowel Syndrome Practical Approach to Management, 2017
Richard Gilroy, Jordan Voss, Chaitanya Pant
Antimicrobial lock solutions have been shown to be effective at reducing catheter colonization and CRBSI, although the level of evidence is of low quality [42]. A lock solution contains a compound with antimicrobial activity, which is “locked” in the catheter for a time period rarely exceeding a day. The solution itself is held within the lumen of the catheter by the catheter’s locking valve and resides between this point and the external hub that connects to the PN infusion cannulas. Various antimicrobials have been evaluated, with no single solution emerging as a best option and each antimicrobial solution having advantages and disadvantages, which vary based on catheter type and the suspected microorganism [54]. An important deficiency of all antimicrobial lock solutions is that the antimicrobial is within the tube and is therefore not active against biofilms that reside outside the catheter wall. A review of randomized controlled trials evaluating taurolidine lock solutions indicates that taurolidine results in lower rates of CRBSI and does not impact the rate of thrombosis [55]. The use of several antibiotics (including aminoglycosides, vancomycin, daptomycin, and tigecycline) in lock solutions has also been evaluated. These studies, including the taurolidine randomized trials, seem to be limited in number and sample size, but in general, the effectiveness of antibiotics in lock solutions seems to be species dependent. Larger prospective in vivo studies are needed before definitive recommendations can be made. For more information on this subject, we recommend the 2015 review article by Vassallo et al. [54].
Surgery, wound healing, and peritoneal minimal residual disease in colorectal cancer
Published in Wim P. Ceelen, Edward A. Levine, Intraperitoneal Cancer Therapy, 2015
As discussed earlier, it has been realized that the mechanisms involved in postoperative wound healing may stimulate the growth of residual cancer cells [127–128]. One of the essential features of both wound healing and tumor growth is angiogenesis. Therefore, postoperative inhibition of angiogenesis may prevent the outgrowth of peritoneal residual cancer. Understandably, however, inhibition of VEGF in the postoperative setting carries the risk of anastomotic and wound healing complications [129]. Thus, in the National Surgical Adjuvant Breast and Bowel Project (NSABP) C-08 trial that compared adjuvant chemotherapy (FOLFOX6) with or without bevacizumab in stage II or III CRC, the proportion of wound complications (incisional hernia, wound dehiscence, and port site dehiscence) was significantly higher in patients who received bevacizumab (1.7% vs. 0.3%, P < 0.01) [130]. Alternatively, one may avoid or suppress the inflammatory response after surgery. In a mouse model, Roh et al. found that the selective cyclo-oxygenase-2 (Cox-2) inhibitor celecoxib had a significant inhibitory effect on tumor growth in the surgical wound when administered daily from 1 day before surgical wounding and tumor implantation [125,126]. Also, restoration of surgery-induced immunosuppression may prevent postoperative locoregional cancer growth [2,131]. Small clinical trials in CRC patients have shown that perioperative systemic administration using IL-2, GM-CSF, or interferon restores postoperative immune function [132–134]. However, their effect on postoperative recurrence or survival is not known. In line with the observed effects of bacterial LPS on tumor apoptosis, anti-LPS therapy using taurolidine abrogated the effects of surgical trauma on primary and metastatic tumor growth in a mouse melanoma model [135]. In CRC patients, preoperative administration of IL-2 significantly reduced postoperative VEGF production and at the same time inhibited the decline of the antiangiogenic cytokine IL-12 [133]. Helguera et al. studied the effects of cytokines fused to antibodies in mice receiving IP HER2/neu expressing tumors and found that combined administration of (1) anti-HER2/neu fused with IL-2 and (2) anti-HER2/neu fused with granulocyte macrophage colony-stimulating factor (GM-CSF) prevented tumor growth in 100% of animals [136]. In preclinical models, IP immunotherapy using cytokines, monoclonal antibodies, or radionuclide antibody conjugates has been successfully used to treat or prevent PC [137].
Recent advances and future perspectives in the pharmacological treatment of Candida auris infections
Published in Expert Review of Clinical Pharmacology, 2021
Daniele R. Giacobbe, Laura Magnasco, Chiara Sepulcri, Malgorzata Mikulska, Philipp Koehler, Oliver A. Cornely, Matteo Bassetti
Recently, two catheter lock solutions known for their antimicrobial activity, taurolidine, and minocycline-EDTA-ethanol (MEE), have been compared in vitro against biofilms of ten strains of C. auris [107], with MEE apparently showing better eradication potential than taurolidine for all tested strains. Of note, a taurolidine-based catheter lock solution is already marketed in the EU for the prevention of catheter-related bloodstream infections in patients undergoing hemodialysis, oncology patients receiving chemotherapy, and patients receiving total parenteral nutrition [108]. Its activity against C. auris has been anticipated in a press release [109], which may prompt further clinical investigation for the prevention of C. auris catheter-related infections.
Implantation of Vascular Access Buttons™ for Prolonged Blood Collection in Venously-Catheterized Ferrets
Published in Journal of Investigative Surgery, 2021
Chelsea R. Boeri, Michael S. Horsmon
Rat jugular vein catheters, rat 1-channel VABs, and PinPort™ injectors were supplied by Instech Laboratories Inc. (Plymouth Meeting, PA). Catheters were received with the following specifications: 3 Fr external diameter, 0.64 mm internal diameter medical grade polyurethane 20 cm in length with silicone collars at 2.5 cm and 2.8 cm, fitting a 22 ga insert. 4-0 Ethibond Excel, 5-0 Vicryl, and 5-0 PDSII sutures were supplied by Ethicon (Somerville, NJ). DuraPrep™ surgical solution (iodine povacrylex and isopropyl alcohol, 74% w/w) was supplied by 3M (Saint Paul, MN). Taurolidine-citrate solution (TCS) was supplied by Access Technologies (Skokie, IL). All other drugs and chemicals were supplied by Patterson Veterinary Supply, Inc. (Devens, MA). Microtainer® EDTA-coated blood collection tubes were supplied by Becton Dickinson (Franklin Lakes, NJ).
Preventing catheter-related infections in cancer patients: a review of current strategies
Published in Expert Review of Anti-infective Therapy, 2020
Alexandre E. Malek, Issam I. Raad
A few studies have shown that taurolidine lock solution reduces CLABSI compared with heparin lock [77]. Also, taurolidine-based catheter lock solutions containing heparin and urokinase reduced infection related to tunneled hemodialysis catheters compared to 4% citrate solution [78]. On the other hand, adding citrate chelator to taurolidine lock solution has been demonstrated to be safe and effective for preventing catheter-related infections in young children [79]. Another study showed that taurolidine-citrate lock solution remarkably reduced the CLABSI rate by 80% among all studied patients, 90% in hematology-oncology patients, and 70% in pediatric patients with gastrointestinal diseases; however, taurolidine could be thrombogenic leading to more thrombotic luminal occlusions of the CVC [80]. Furthermore, taurolidine lock has shown to decrease CRBSI when compared to heparin in patients on parenteral nutrition [81]. Similarly, taurolidine-citrate-heparin catheter lock and taurolidine-citrate lock have demonstrated a remarkable reduction of CRBSI occurrence in a high-risk population depending on parenteral nutrition compared with heparin lock [82,83].