Explore the vast range of titles available.

Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.

Objective: To compare the efficacy of TaurolockHEP500®, as half and one third of standard dose on prevention of catheter related blood stream infection (CRBSI) and catheter dysfunction in patients undergoing hemodialysis via tunneled double lumen catheter. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Nephrology, Armed Forces Institute of Urology, Rawalpindi, Pakistan, and Pak Emirates Military Hospital Rawalpindi, Pakistan from Sep, 2023 to Apr, 2024. Methodology: The study recruited 314 patients, were divided into two groups; Group-A (n=157) and Group-B (n=157). Injection TaurolockHEP500® was administered into the tunneled double lumen catheter as half doses for Group-A and one third doses for Group-B. The rest of the space in catheter's lumen was filled with heparin. All the patients were then followed for 3 months. Blood samples for culture and sensitivity, were taken from both ports of their tunneled catheters and from a peripheral vein simultaneously to confirm CRBSI during fever spike in hemodialysis. Moreover, blood flow rates were monitored during each session to detect catheter dysfunction. Results: Catheter function and blood culture didn't show a significant difference among two study groups (Group-A and Group-B) with p-values 0.702 and 0.556 respectively. Conclusion: The catheter lock solution TaurolockHEP500® even in one third dose, after each session of hemodialysis, can significantly reduce the rate of bacteremia and catheter dysfunction.

Influenza virus causes worldwide outbreaks and seasonal epidemics, posing a severe threat to public health and social development. Effective prevention and treatment of influenza infections remain major challenge for global healthcare. In this study, we observed that taurolidine effectively inhibited the proliferation of several human or animal influenza virus strains and protected mice from lethal-infection. Taurolidine treatment decreased the viral titer in the lungs of infected mice, reduced the ratio of immune cells, and alleviated lung pathology. Additionally, taurolidine treatment attenuated the rise of blood pressure, pulse wave velocity, and pulmonary aortic thickness in a mouse model for influenza virus infection. We also found that taurolidine significantly decreased intracellular Ca 2+ concentration and effectively alleviated pulmonary artery vasoconstriction during influenza virus infection. Mechanistically, we observed that vascular smooth muscle contraction signaling pathway was significantly enriched, and taurolidine inhibited the activation of the MLCK/p-MLC pathway. Taking together, these findings confirm the effectiveness of taurolidine as an antiviral agent and highlight its important roles in mitigating host immune cell infiltration and vasoconstriction induced by influenza virus infection.

•The application of taurolidine is effective in prevention and treatment of catheter-related bloodstream infection.•Lowering the concentration of taurolidine to 0.625% did not significantly deteriorate the taurolidine lock's effectiveness.•At the same time, increasing the concentration of taurolidine does not lead to its greater effectiveness.•Taurolidine is more effective on Gram-negative bacteria after 30 min of exposure. To evaluate the effectiveness of various taurolidine solutions in the prevention and treatment of catheter-related bloodstream infections (CRBSIs) caused by the entire spectrum of microbes in patients receiving parenteral nutrition in a shorter period of time. The in vitro method was used to test for eradication of biofilm. Different locks were used: TauroSept (2%), TauroLock (1.35%), TauroLock half concentration, and 3.5% taurolidine and tested on Staphylococcus (S.) epidermidis, S. aureus, S. hominis, methicillin-resistant S. aureus (MRSA), Pseudomonas (P.) aeruginosa (PSAE), multidrug‐resistant P. aeruginosa (MR PSAE), vancomycin-resistant enterococci, Klebsiella pneumoniae producing carbapenemase (KPC), Klebsiella pneumoniae producing extended-spectrum beta-lactamase (KLPN ESBL), Candida (C.) albicans, and C. glabrata. Broviac catheters were incubated for growth of each organism and then incubated in lock solutions. Colony forming units (CFUs) were then counted after 30 min, 60 min, and 120 min of incubation. A statistically significant decrease in CFUs was observed after 30 min of taurolidine exposure for S. hominis, PSAE, KLPN ESBL, KLPN KPC, C. albicans, and C. glabrata; after 60 min of exposure for S. epidermidis, PSAE, MR PSAE, KLPN ESBL, KPC, C. albicans, and C. glabrata; and after 120 min of exposure for S. epidermidis, S. hominis, S. aureus, PSAE, MR PSAE, KLPN ESBL, KPC, C. albicans, C. glabrata. The application of taurolidine is effective in the treatment of CRBSIs. Taurolidine proved to be more effective against Gram-negative microorganisms during a 30-min exposure. Using 0.675% taurolidine is still effective. To achieve the required antimicrobial effect, the catheter must be sanitized for at least 2 h.

Background/Aim: Although taurolidine is known to exert a wide spectrum of biological actions, its effects on immune cells have not been characterized in detail. In this study, we investigated the ex vivo effects of taurolidine on relevant innate and adaptive immune cell functions. Materials and Methods: Leukocyte functions in whole blood were assessed following treatment with various taurolidine concentrations. Viability of peripheral blood mononuclear cells (PBMCs) and granulocytes was measured using the WST-1 assay. PBMC function was assessed by measuring TNFα and IFNγ production after stimulation with lipopolysaccharide (LPS) or Candida, respectively. Reactive oxygen species (ROS) production by granulocytes was measured in whole blood using luminol-enhanced chemiluminescence. Granulocyte degranulation and activation were evaluated by membrane expression of degranulation (CD63, CD66B) and adhesion markers (CD62L, CD11b) using immunofluorescent staining followed by flow-cytometric analysis. Results: Taurolidine decreased viability of PBMCs and granulocytes: after 2 h, IC50 concentrations were 500 and 520 μg/ml, respectively. Following prolonged exposure (≥24 h) of PBMCs, the IC50 concentrations declined to 40 μg/ml. PBMC cytokine production significantly decreased at taurolidine concentrations below the cytotoxic threshold, whereas no changes in ROS production were observed. The expression of all granulocyte adhesion and degranulation markers increased at concentrations higher than 500 μg/ml (the cytotoxic level of taurolidine). Conclusion: Taurolidine exhibits a dose- and time-dependent cytotoxicity toward PBMCs and granulocytes. The effects on PBMCs, as exemplified by a decrease in cytokine production, occurred below the toxic threshold, whereas granulocyte function (ROS production) remained unchanged at these taurolidine concentrations. Granulocyte activation and degranulation markers only increased at cytotoxic taurolidine concentrations.

Background SARS-CoV-2 and influenza virus are highly contagious respiratory viruses that continuously pose major threats to human and public health. The high frequency of viral mutations led to the emergence of resistant isolates and caused virus epidemics repeatedly, emphasizing the urgent need to develop new antivirals. Taurultam is a metabolite of taurolidine. Moreover, taurolidine has been shown to have potent antiviral activities against multiple viruses and to have antiviral effects through its metabolites. Results In this study, we sought to determine the antiviral activities of taurultam against SARS-CoV-2 and influenza virus in Vero-E6, Huh7, 293T-ACE2, and MDCK cell lines and mouse infection models. The results showed that taurultam exhibited potent antiviral activity against multiple SARS-CoV-2 variants, influenza A (H1N1, H3N2) virus and influenza B virus, in vitro. Moreover, in influenza A (H1N1) virus, influenza B virus and SARS-CoV-2 infection models, taurultam significantly reduced viral loads, increased survival, improved mouse body weight and lung injury. Surprisingly, taurultam treatment not only inhibited the influenza A virus and SARS-CoV-2, but also benefited for therapy of mixed infection of these two viruses in vitro, demonstrating the great antiviral potential of taurultam for the treatment of SARS-CoV-2 and influenza virus infections. Conclusions Together, our findings identify taurultam as a new candidate for the treatment of SARS-CoV-2 and influenza virus infections, especially virus-induced lung pathology. Clinical trial number Not applicable.

Introduction Cardiac implantable electronic device (CIED) complications present significant challenges in clinical practice, especially in elderly patients with multiple comorbidities. Common adverse events include infection, lead malfunction, and device migration. Twiddler’s Syndrome, a rare but serious CIED complication characterised by patient manipulation causing lead displacement and device malfunction, is often underreported. The literature consists mainly of case reports and small series, providing limited guidance on prevention and management. As CIEDs are critical for managing cardiac arrhythmias and heart failure, understanding and addressing Twiddler’s Syndrome is essential. This case report aims to contribute to the literature by detailing a case of Twiddler’s Syndrome, emphasising the importance of a multidisciplinary approach for optimal management. Case Presentation A 59-year-old male presented with discomfort around his implantable cardioverter defibrillator (ICD) site and the sternal area over the past two days. He denied pain, dyspnoea, or dizziness. Clinical examination revealed a normal heart rhythm and no peripheral pulse deficit. Ultrasound revealed a reduced left ventricular ejection fraction. The atrial lead was not visible, and the shock coil was misplaced. ICD interrogation showed inappropriate shocks due to sensing artifacts and exit block in both leads, with no arrhythmias detected. An X-ray confirmed lead dislodgement and significant entanglement in the pocket. The patient was diagnosed with Twiddler’s Syndrome and scheduled for surgical revision. Discussion/Conclusions Dilated cardiomyopathy (DCM), characterised by left ventricular dilatation and dysfunction, accounts for a significant proportion of systolic heart failure cases. Despite advancements in heart failure management, DCM patients remain at high risk for sudden cardiac death (SCD), making ICD implantation crucial. However, CIED placement carries risks of complications, including Twiddler’s Syndrome. This condition can lead to lead dislodgement and device malfunction, resulting in inappropriate shocks and potential patient harm. In this case, a single-session extraction and re-implantation were successfully performed using a multidisciplinary approach, emphasising the importance of comprehensive management strategies to address such complications effectively. Regular follow-up showed no adverse events, highlighting the procedure’s success and the potential benefits of using advanced antimicrobial adjuncts to prevent infections. This case underscores the need for awareness and standardised protocols for managing Twiddler’s Syndrome to improve patient outcomes in the growing population of CIED recipients.

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.

Catheter-related bloodstream infections (CRBSIs) are one of the most severe complications in children with intestinal failure (IF) who require long-term parenteral nutrition (PN). Taurolidine-citrate solution (TCS), with proven antimicrobial and antibiofilm properties, has been proposed as a promising alternative to heparin locks for preventing infection. The aim is to evaluate the efficacy and safety of the TCS in reducing the rates of CRBSI and pathogen-specific infections in pediatric patients with indwelling central venous catheters (CVCs) who are receiving PN. This retrospective study included 48 pediatric IF patients treated at an intestinal rehabilitation and transplantation center in Türkiye. Patients received either TCS or heparinized saline (0.9% saline solution containing 100 IU of heparin) as a catheter lock. Infection data were extracted from medical records and expressed as events per 1000 catheter days. Group comparisons were performed using non-parametric tests, and Poisson regression was applied to calculate rate ratios (RRs) and 95% confidence intervals (CIs). Adjusted rate ratios were obtained from a Poisson regression model that included the following variables: age, sex, diagnosis category, ostomy status, catheter type, and follow-up duration. Log(catheter-days) was incorporated as an offset term. Overdispersion was assessed and not detected. The crude CRBSI rate was lower in the TCS group than in the heparinized saline group (29.4 vs. 42.8 per 1000 catheter days), though this difference was not statistically significant ( = 0.383). However, after adjustment by Poisson regression, TCS use was significantly associated with reduced infection rates (adjusted RR = 0.78, 95% CI = 0.70-0.87, < 0.001). TCS use was also significantly associated with reduced rates of Gram-positive (RR = 0.78, = 0.006), Gram-negative (RR = 0.48, < 0.001) and fungal (RR = 0.63, < 0.001) infections. No adverse events were observed among the TCS group. Standardized TCS lock therapy effectively and safely reduces CRBSIs in pediatric patients with IF, particularly those caused by Gram-negative and fungal organisms. These results support the use of TCS as a prophylactic option for preventing infection in long-term CVC use.

BackgroundSurgical site infections following median sternotomy are common and can lead to extended hospital stays, prolonged courses of intravenous antibiotics, increased healthcare costs, and, in many cases, the need for repeated debridement or additional surgical interventions. Recognizing this significant unmet clinical need, we adopted an alternative approach in the present case report to address and resolve the problem.Case presentationWe herein report a case of a 52-year-old female patient, that developed a deep incisional infection with localized dehiscence after a median sternotomy performed for left atrial myxoma removal. Klebsiella aerogenes was cultured from the wound swabs and, despite prolonged intravenous antibiotic therapy and regular debridement we were unable to obtain culture negativity or wound healing over the course of several weeks. A commercially available Taurolidine 2% solution was employed every other day to irrigate the wound, which led to culture negativity within five days. Complete reepithelization was reached after a total of five weeks.ConclusionReports of various taurolidine solutions promoting healing in complex wound lesions are scarcely available. In our case it proved to be an effective therapeutic option, preventing the need for additional surgical intervention and facilitating healing by secondary intention.