2239. A Novel Non-Antibiotic Nitroglycerin Based Catheter Lock Solution for the Prevention of Intraluminal Central Venous Catheter Related Bloodstream Infections (CRBSI) in Cancer Patients
Session: Poster Abstract Session: New Antibiotics in Development
Saturday, October 29, 2016
Room: Poster Hall
Background: For long-term central venous catheters (CVC), the lumen is the major source of catheter-related bloodstream infections (CRBSI). The current standard of care for maintaining catheter patency includes flushing the CVC with either saline or heparin. Neither agent has any antimicrobial activity and heparin enhances staphylococcal biofilm. We evaluated the safety and efficacy of a novel non-antibiotic intraluminal catheter lock solution in preventing CRBSI. We anticipated a 50% reduction in the rate of CRBSI compared to the same patient population without lock.

Methods: Between November 2015 to February 2016, we enrolled 60 patients with hematologic malignancies who had dual-lumen PICC lines that have been in place for at least 14 days. This was a dose escalation, two dose trial. The study lock consisted of a solution that contains 15 or 30 micrograms/mL of nitroglycerin in combination with 4% sodium citrate and 22% ethanol (NiCE). The patient received 1ml of the solution in each lumen on a daily basis for two hours as inpatient. The lock was flushed after two hours. After discharge, patients received the lock as outpatients once a week for up to 30 days. Patients were subsequently followed for 30 days after last dose.

Results: After enrolling 10 patients at the lower nitroglycerin dose without evidence of toxicity, the dose was escalated to the higher dose (30 micrograms/ml). Patients received a total of 620 catheter-days (CD) with NiCE lock. There were no serious related adverse events or episodes of hypotension observed with lock administration. One patient experienced a mild transient headache possibly related to the lock that resolved within minutes without residual effect. We observed no CRBSI during daily lock administration compared to a rate of CRBSI of 1.6/1,000 CD during the days when patients were off lock therapy; whereas the rate of CRBSI was 1.9/1000 CD in the historical control group.

Conclusion: The NiCE lock therapy was safe and well tolerated. No CLABSI was observed while on daily lock with 100% reduction in CRBSI rate. Large, prospective, randomized clinical trials are needed to validate these findings.

Anne-Marie Chaftari, MD1, Ray Hachem, MD, FIDSA2, Ariel D. Szvalb, MD3, Mahnaz Taremi, MD, MPH4, Bruno Granwehr, MD5, George M. Viola, MD, MPH6, Amin Sapna, PharmD7, Andrew Assaf, MD8, Yazan Numan, MD8, Pankil Shah, MD, MSPH6, Edd Felix, BS7, Elizabeth Natividad, BSN9, Ying Jiang, MS10, Rebecca Slack, BA11, Ruth Reitzel, MS1, Joel Rosenblatt, PhD12, Elie Mouhayar, MD7 and Issam Raad, MD, FIDSA, FSHEA13, (1)Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, (2)University of Texas, M.D. Anderson Cancer Center, Houston, TX, (3)Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (4)Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, (5)Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (6)The University of Texas MD Anderson Cancer Center, Houston, TX, (7)MD Anderson Cancer Center, Houston, TX, (8)UT MD Anderson Cancer Center, Houston, TX, (9)Infusion Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, (10)The University of Texas M. D. Anderson Cancer Center, Houston, TX, (11)University of Texas MD Anderson Cancer Center, Houston, TX, (12)1515 Holcombe - Suite FCT12.6030, UT MD Anderson Cancer Center, Houston, TX, (13)UT M.D. Anderson Cancer Center, Houston, TX

Disclosures:

A. M. Chaftari, None

R. Hachem, None

A. D. Szvalb, None

M. Taremi, None

B. Granwehr, None

G. M. Viola, None

A. Sapna, None

A. Assaf, None

Y. Numan, None

P. Shah, None

E. Felix, None

E. Natividad, None

Y. Jiang, None

R. Slack, None

R. Reitzel, None

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: Inventors of the Nitroglycerin Based 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

E. Mouhayar, 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: Inventors of the Nitroglycerin Based 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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