419. Antimicrobial Efficacy of Optimized Nitroglycerin+Citrate+Ethanol (NiCE) compared to Taruolidine+Citrate+Heparin (TCH) Catheter Lock Solutions against an Extended Panel of Highly Resistant Pathogens Including Vancomycin Intermediate Staphylococcus aureus (VISA) and Carbapenem-resistant Enterobacteriaceae (CRE)
Session: Poster Abstract Session: HAI: Preventing Device-Associated Infections
Thursday, October 27, 2016
Room: Poster Hall
Background: Antimicrobial catheter lock solutions (ACLS) are a promising approach to prevent Central Line Associated Blood Stream Infections (CLABSIs). Increased use of antimicrobials has promoted resistant organisms such as CRE, VISA, and azole resistant Candida glabratathat can have CLABSI mortality rates as high as 50%. This drives the need for improved prophylactic ACLS that can prevent these infections. Previously we reported that the synergistic combination of 0.0015-0.003% GTN + 4% Citrate + 22% Ethanol (NiCE) catheter lock solution was highly effective in rapidly eradicating biofilm formed by common CLABSI pathogens. TCH, which has been clinically tested and shown reduction in CLABSIs, was used as a comparator. In this study we evaluated the antimicrobial efficacy of NiCE ACLS compared to TCH ACLS against an extended spectrum of highly resistant organisms.

Methods: Efficacy of NiCE was compared to TCH (1.35% Taurolidine + 3.5% Citrate + 1000U/mL Heparin) for antimicrobial efficacy against clinical isolates of CRE Klebsiella pneumoniae, CRE E. coli, VISA and C. glabratafrom our hospital using the modified Kuhn’s biofilm eradication model. Briefly, silicone discs were exposed to organism for 24 hours to allow biofilm to form on the surface of the discs. Discs were then washed to remove any unattached organisms and exposed independently to NiCE or TCH ACLS for 2 hours. After exposure, discs were then sonicated to disrupt any biofilm and plated to enumerate any viable organisms. Discs exposed to Muller Hinton broth were used as controls.

Results: NiCE ACLS demonstrated compete eradication of all CRE, VISA, and C. glabrata organisms in biofilms within 2 hours. TCH eradicated all CRE organisms in biofilms within 2 hours but did not fully eradicate VISA and C. glabarataorganisms in biofilms. NiCE was significantly superior to TCH against both VISA (p=0.004) and C. glabarata (p=0.04).

Conclusion: Non-antibiotic and heparin-free Nitroglycerin+Citrate+Ethanol (NiCE) catheter lock solution rapidly eradicated resistant CRE, VISA and C. glabarata organisms in biofilm and was significantly superior to Taurolidine+Citrate+Heparin catheter lock solution in eradicating resistant VISA and C. glabrata organisms in biofilms.

Joel Rosenblatt, PhD1, Ruth Reitzel, MS2, Anne-Marie Chaftari, MD2, Ray Hachem, MD, FIDSA3 and Issam Raad, MD, FIDSA, FSHEA4, (1)UT MD Anderson Cancer Center, Houston, TX, (2)Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, (3)University of Texas, M.D. Anderson Cancer Center, Houston, TX, (4)UT M.D. Anderson Cancer Center, Houston, TX

Disclosures:

J. Rosenblatt, the University of Texas MD Anderson Cancer Center: Inventor of the Caprylic Acid - Glycerol Trinitrate Combination Technology and Shareholder , licensed by Novel Anti-Infective Technologies, LLC in which UTMDACC, Dr. Raad and Dr. Rosenblatt are shareholders. and Licensing agreement or royalty
The University of Texas MD Anderson Cancer Center: are inventors of the Nitroglycerin-Citrate-Ethanol catheter lock solution technology and Shareholder , licensed by Novel Anti-Infective Technologies, LLC in which UTMDACC, Dr. Raad and Dr. Rosenblatt are shareholders. and Licensing agreement or royalty

R. Reitzel, None

A. M. Chaftari, None

R. Hachem, None

I. Raad, the University of Texas MD Anderson Cancer Center: Inventor of the Caprylic Acid - Glycerol Trinitrate Combination Technology and Shareholder , licensed by Novel Anti-Infective Technologies, LLC in which UTMDACC, Dr. Raad and Dr. Rosenblatt are shareholders and Licensing agreement or royalty
The University of Texas MD Anderson Cancer Center: Inventor of the Nitroglycerin-Citrate-Ethanol catheter lock solution technology and Shareholder , licensed by Novel Anti-Infective Technologies, LLC in which UTMDACC, Dr. Raad and Dr. Rosenblatt are shareholders and Licensing agreement or royalty

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