Background The two main complications for patients dialysed by a central catheter are intra-luminal thrombosis and bacterial colonisation.
Purpose We referenced a new prefilled syringe: a strong 46.7% citrate concentration. We estimated the impact of the citrate solution on bacterial colonisation. We also evaluated economic impact with regard to the former reference taurolidine 1.35%+citrate 4%.
Material and methods This was a 9 month retrospective study on 377 dialysed patients including 55 fitted with a catheter divided in two periods: period A (patients receiving taurolidine 1.35%+citrate 4%) and period B (patients receiving citrate 46.7%). The number of infections caused by the catheter was established by correlation between antibiotic prescriptions delivered by the pharmacy and infections registered by a nurse hygienist. The infections with the catheter were confirmed by signs of infections and fever. This led to the identification of haemocultures. A positive result granted prescription of antibiotics.
The economic impact was estimated by comparing the use of the former solution, which was systematically associated with heparin 25 000 UI, against citrate 46.7%.
Results For 3135 sessions of dialysis in period A, 19 infections were observed either 6.0% dialyses, against 19 infections on 3300 sessions of dialyses in period B, either 5.7%. This small decrease in infection with the citrate solution 46.7% was not significant. The economic impact was significant, with a decrease of 31% (ie, 7.6€ by patient). Indeed, in period A, the use of taurolidine 1.35%+citrate 4%+heparin solution costs 10 906€ compared with 7569€ in period B, using citrate 46.7%.
Conclusion This study on infectious episodes does not allow us to to state the superiority of one solution over the other. Patients presented with infectious episodes over the two periods (that is, susceptibility increased for these patients because of associated pathologies (diabetes), age of the catheter, quality of the care, etc). Citrate 46.7% referencing had a consequent economic impact. From a hygiene and good practice point of view, this new prefilled syringe decreases manipulations.
No conflict of interest.
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