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Catheter-related bloodstream infections represent one of the most prevalent complications in patients with peripherally inserted central venous catheters (PICCs). The application of antibiotic lock therapy (ALT), particularly in patients with hematological malignancies, has not been well documented. We aim to share our experience on ALT for these patients and to evaluate its effectiveness and safety. All cases of patients with hematological malignancies who had PICC from January 2018 to October 2024 were retrospectively reviewed. Microbiologic data of PICC-related bloodstream infections (PRBSIs) were collected. A comparison was made between patients managed with ALT and those without it. Factors affecting PICC removal were also explored. A total of 45 patients experienced 67 episodes of PRBSIs, yielding an incidence rate of 2.98 per 1,000 PICC days. The median time of PRBSI onset was 42 days. Predominant pathogens included Gram-negative bacilli (49.3%) and Gram-positive cocci (35.8%). The catheter salvage rate was significantly higher at 76.5% when ALT was combined with systemic antibiotic therapy (SAT), compared to 51.5% for SAT alone ( p  = 0.033). 3 death events (3/34) compared with 4 death events (4/33) occurred in each therapeutic regimen ( p  = 0.709). Elevated procalcitonin levels (> 2ng/ml) and inadequate empirical therapy were risk factors for PICC removal; conversely, ALT served as a protective factor against it. ALT in combination with systemic antibiotics is a safe and effective approach for managing PRBSIs in patients with hematological malignancies, helping to avoid unnecessary catheter removal and could be considered in clinical practice when catheter retention is desired.

Candida auris is a potential multidrug-resistant pathogen able to persist on indwelling devices as a biofilm, which serve as a source of catheter-associated infections. Neosartorya fischeri antifungal protein 2 (NFAP2) is a cysteine-rich, cationic protein with potent anti-Candida activity. We studied the in vitro activity of NFAP2 alone and in combination with fluconazole, amphotericin B, anidulafungin, caspofungin, and micafungin against C. auris biofilms. The nature of interactions was assessed utilizing the fractional inhibitory concentration index (FICI), a Bliss independence model, and LIVE/DEAD viability assay. NFAP2 exerted synergy with all tested antifungals with FICIs ranging between 0.312–0.5, 0.155–0.5, 0.037–0.375, 0.064–0.375, and 0.064–0.375 for fluconazole, amphotericin B, anidulafungin, caspofungin, and micafungin, respectively. These results were confirmed using a Bliss model, where NFAP2 produced 17.54 μM2%, 2.16 μM2%, 33.31 μM2%, 10.72 μM2%, and 111.19 μM2% cumulative synergy log volume in combination with fluconazole, amphotericin B, anidulafungin, caspofungin, and micafungin, respectively. In addition, biofilms exposed to echinocandins (32 mg/L) showed significant cell death in the presence of NFAP2 (128 mg/L). Our study shows that NFAP2 displays strong potential as a novel antifungal compound in alternative therapies to combat C. auris biofilms.

Background and aims Central venous catheters (CVCs) are essential for drug delivery in pediatric oncology patients but are associated with complications such as infection and thrombosis. This study aimed to compare the effects of taurolidine–citrate and unfractionated heparin lock solutions on catheter function, infection and thrombosis rates, and inflammatory markers in children with malignancies. Methods In this randomized, controlled trial, 76 pediatric oncology patients were allocated to receive either TauroLock ™ -HEP500 (containing taurolidine, 4% citrate, and 500 IU/mL heparin) or standard unfractionated heparin as the catheter lock solution. Patients were followed for 6 months. Laboratory evaluations, including complete blood count (CBC), high-sensitivity C -reactive protein (hs-CRP), and interleukin-6 (IL-6), were performed at baseline, 1 month, and 6 months, or upon clinical suspicion of infection. Results At 6 months, hs-CRP levels were significantly lower in the taurolidine–citrate group (2.1 ± 0.2 vs. 5.5 ± 2.2, p  = 0.001), as was total WBC count (3792.1 ± 325.3 vs. 4994.5 ± 462.1, p  = 0.028). IL-6 levels showed no statistically significant difference (9.2 ± 1.9 vs. 14.0 ± 3.1, p  = 0.067). The incidence of catheter-related infections (HR 3.55, 95% CI 0.68–18.4, p  = 0.460) and thrombosis (HR 4.13, 95% CI 0.43–39.91, p  = 0.221) did not differ significantly between groups. Conclusion Taurolidine–citrate exhibited a modest anti-inflammatory effect, reflected by reduced hs-CRP and WBC levels, without significant improvement in catheter-related complications or IL-6. The lack of major clinical benefit may relate to the heterogeneous and immunocompromised nature of pediatric oncology patients. Larger, adequately powered studies are warranted to clarify the long-term efficacy and safety of taurolidine–citrate in this population. Clinical Trials as IRCT20201107049296N4.

Biofilm formation often represents significant challenges in managing of bloodstream infections associated with catheter use. Antimicrobial lock therapy serves as an adjunctive treatment for catheter-related infections, effectively eradicating or inhibiting biofilm growth. This review synthesizes the current knowledge on antifungal lock therapy (ALT) targeting clinically common fungi, primarily species, based on both in vitro and in vivo studies (animals and patients) from the past decade. Amphotericin B (AmB) and echinocandins are identified as the most promising antifungal agents for ALT. Combinations of antifungal agents with other compounds, such as farnesol, antifungal protein 2, 8-hydroxyquinoline-5-(N-4-chlorophenyl) sulfonamide, and polyurethane, have also shown efficacy in ALT. Additionally, ethanol, doxycycline, tigecycline, and minocycline lock solutions can be effective in treating fungal infections. More comprehensive investigations and additional rigorous clinical trials are essential to thoroughly understand the safety and efficacy of ALT. This will facilitate the development of novel treatments for catheter-related fungal infections, thereby improving clinical outcomes.

The management of fungal catheter-related bloodstream infections (CRBSIs) in the hemodialysis population represents a critical collision between rigorous infectious disease guidelines and the grim clinical reality of vascular access exhaustion. While guidelines from the IDSA and KDIGO unequivocally recommend immediate catheter removal to prevent metastatic complications, nephrologists are frequently confronted with patients for whom the current catheter represents the last viable lifeline. This review provides a comprehensive analysis of the “catheter salvage” dilemma, moving beyond superficial treatment algorithms to explore the molecular and structural mechanisms that make fungal biofilms a formidable adversary. We dissect the pathogenesis of Candida colonization on abiotic surfaces (silicone and polyurethane), detailing the transition from yeast to hyphal structures and the secretion of a complex extracellular matrix (ECM). We highlight how the ECM, rich in β-1,3 glucan, acts as a physical shield that sequesters azoles, rendering standard systemic therapy ineffective despite in vitro susceptibility. Furthermore, we discuss the role of metabolically dormant “persister cells” in driving high relapse rates and analyze the epidemiological shift toward Candida parapsilosis , a pathogen with a unique affinity for foreign bodies and parenteral nutrition lines. Diagnostically, we scrutinize the limitations of traditional blood cultures and the “Differential Time to Positivity” (DTP) criteria, arguing that the slower growth kinetics of fungi render DTP unreliable compared to bacterial infections. The core of this review evaluates the efficacy and safety of Antifungal Lock Therapy (ALT) as a bridging strategy. We provide a comparative analysis of lock agents, contrasting the broad lytic potential of ethanol (the “nuclear option”) with the safety profile of taurolidine and the pharmacological nuances of amphotericin B and echinocandins. Ultimately, we propose that while catheter removal remains the gold standard, a nuanced mastery of biofilm biology and lock therapy protocols is essential for managing complex, access-challenged patients where immediate removal is not feasible.

Catheter-related bloodstream infections (CRBSIs) are an important problem in pediatric patients with central venous catheters. This study aimed to determine the incidence of CRBSIs, responsible pathogens and outcomes of antibiotic lock treatment (ALT) in pediatric patients. Between January 2010 and November 2015 all hospitalized pediatric hematology, oncology and immunology patients diagnosed with CRBSIs were retrospectively analyzed. Seventy-eight CRBSI episodes were detected in 60 pediatric patients. The incidence of CRBSIs was 4.20/1000 catheter days. The most frequently detected pathogen was methicillin-resistant coagulase-negative Staphylococcus. Pseudomonas aeruginosa, Klebsiella spp., and Escherichia coli were other commonly isolated microorganisms. ALT was administered in 42 patients. The success rate of ALT was 81% (34/42). Catheter was removed without ALT in 36 episodes. Common reasons for catheter removal were sepsis and causative microorganisms which had high probability of biofilm formation. CRBSIs are an important cause of morbidity and mortality in pediatric patients. ALT is safe and effective. It is possible to obtain satisfactory results when ALT is used with intravenous systemic antibiotics for CRBSIs, though in some cases catheter removal is necessary. ALT helps to prevent unnecessary catheter removal in pediatric patients.

Life-threatening central venous catheter-related infections are primarily initiated by biofilm formation on the catheter surface. Antibiotic lock therapy is recommended for eradicating intraluminal biofilm. In the era of antibiotic resistance, antibiotics of natural origins provide an effective and cheap option for combating resistant strains. Garlic especially stole the spotlight because of its impressive antimicrobial effectiveness against such superbugs. Is to estimate the potential use of fresh garlic extract (FGE) as a lock agent against multi-drug resistant (MDR) bacteria. The agar well diffusion and broth microdilution techniques were employed to test the antimicrobial activities of FGE against five MDR strains; E. coli, Pseudomonas aeruginosa (P. aeruginosa), Klebsiella pneumoniae (K. pneumoniae), Serratia marscens (S. marscens) and Methicillin-resistant Staphylococcus aureus (MRSA). Then the protective and therapeutic efficiencies of FGE against bacterial biofilms were in-vitro evaluated; at concentrations of 100, 75, 50 and 25%; in tissue culture plate (TCP) and on the polyurethane (PU) sheets using the crystal violet (CV) assay and colony-forming unit (CFU), respectively. Scanning electron microscopy (SEM) was also used to confirm eradication of biofilms on PU sheets. Finally, systemic and deep tissue infections by P. aeruginosa and MRSA were induced in mice that were then treated by FGE at either 100 or 200 mg/kg for seven days. Where the antibacterial activity was assessed by tissue and blood culturing at the end of the treatment period. Biochemical, hematological and histological parameters were also investigated. FGE exhibited potent in-vitro and in-vivo antibacterial and antibiofilm activities against MDR strains. It not only didn’t exhibit toxicological effects at the hematological and the histological levels but also provided protective effects as demonstrated by the significant drop in the biochemical parameters. FGE has the potential to be used as a prophylactic and/or therapeutic lock agent against biofilm-associated infections caused by MDR bacteria.

Objective: This study aimed to describe the main microorganisms causing catheter-related bloodstream infections (CRBSIs) and to evaluate the effectiveness of taurolidine catheter lock therapy in children with intestinal failure (IF) receiving parenteral nutrition (PN). Study design: This retrospective study included 31 pediatric patients with IF admitted between 2017 and 2022 who received PN via central venous catheters (CVCs). Demographic, clinical, and laboratory data were collected, along with information on PN use, catheter characteristics, and infection episodes, including clinical signs, microbiological cultures, and antimicrobial therapy. Serum C-reactive protein and albumin levels, as well as the use of taurolidine lock therapy, were analyzed. Results: The median age was 54.4 days among patients who developed CRBSI and 154.1 days among those without CRBSI. The median duration of PN was 119 days in patients with CRBSI and 89 days in those without. Nineteen patients experienced CRBSI, accounting for 55 infection episodes confirmed by blood cultures obtained from CVCs. The most frequently isolated microorganisms were Staphylococcus epidermidis, Enterococcus faecalis, and Klebsiella pneumoniae. Taurolidine lock therapy was significantly associated with lower infection rates per 1000 catheter days, with most infected catheters and infection episodes occurring in the absence of taurolidine use. Conclusions: These findings contribute to the characterization of the microbiological profile of CRBSIs in pediatric patients with IF and support the use of advanced preventive strategies, such as taurolidine lock therapy, to reduce infection rates in children receiving long-term PN.

While proliferating in its most common mode of growth, a biofilm, Candida spp. exhibit increased resistance to available antifungal agents. These adherent communities are difficult to eradicate and often responsible for treatment failures. New therapies are urgently needed to treat a variety of Candida biofilm infections in the medical setting. This review discusses the medical relevance of Candida biofilms, the drug resistance associated with this mode of growth, and approaches to combat these resilient infections.

Candida forms a gel-like biofilm in the Foley’s catheter (FC) causing tenacious biofouling and severe urinary tract infections (UTIs). For the first time, a spice extract-based antifungal lock therapy (ALT) has been developed to inhibit the Candida albicans gel matrix in FC. Aqueous extracts of garlic, clove, and Indian gooseberry were used as ALT lock solutions and tested against biofilm-forming multidrug-resistant clinical isolates of C. albicans. Reduction in the gel matrices formation in the catheter was confirmed by Point inoculation, MTT assay, CFU, and SEM analysis at 12 and 24 h of incubation. Garlic was effective in controlling both C. albicans M207 and C. albicans S470; however, clove and gooseberry effectively controlled the latter. As evidenced by CFU assay, there were 82.85% and 99.68% reductions in the growth of C. albicans M207 and S470, respectively, at 24 h of incubation. SEM revealed a switch from the biofilm to the yeast mode and a drastic reduction in cell numbers, with mostly clumped or lysed cells. The study will provide an impetus to the development of novel spice extract-based ALT, reducing the selection pressure on the pathogen and lowering antimicrobial resistance. Further research in this area has the potential to leverage clinical applications.