Eradication of Microorganisms Embedding in Biofilm by a Dose-Dependent Urokinase-Based Catheter Lock Solution in

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Jiayi Wang1, Xiaofei Peng2, Wenqing Yin1

  • 1Department of Nephrology, The Second Xiangya Hospital, Central South University, Key Lab of Kidney Disease and Blood Purification in Hunan, Changsha, China.

Blood Purification
|January 15, 2020
PubMed

Insights

Urokinase plasminogen activator (uPA)-based antibiotic lock therapy effectively removes biofilm-forming bacteria from central vein catheters in hemodialysis patients. This uPA-based approach demonstrates safety and superior efficacy in treating catheter-related blood stream infections compared to heparin-based therapy.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Biotechnology

Background:

  • Catheter-related blood stream infection (CRBSI) is a major complication in hemodialysis (HD) patients, associated with significant morbidity and mortality.
  • Antibiotic lock therapy (ABL) is a key treatment for salvaging central vein catheters (CVCs) in CRBSI cases.
  • Urokinase plasminogen activator (uPA)-based ABL offers potential antimicrobial and biofilm-degrading properties for CRBSI treatment.

Purpose of the Study:

  • To evaluate the in vitro effectiveness of uPA-based ABL against microorganisms within biofilms.
  • To assess the in vivo catheter salvage rate in HD patients with CRBSI using uPA-based ABL.

Main Methods:

  • In vitro: Biofilm formation on HD catheters was induced; uPA with/without antibiotics was applied to assess antimicrobial and biofilm removal.
  • In vivo: 86 HD patients with CRBSI were retrospectively analyzed, comparing uPA-based ABL to heparin-based ABL for catheter salvage.

Main Results:

  • uPA demonstrated efficacy against Staphylococcus epidermidis biofilms, with limited regrowth observed.
  • The combination of uPA and antibiotics showed superior antimicrobial and antibiofilm activity in vitro and in vivo compared to uPA alone or heparin-based ABL.
  • uPA-based ABL was safe in HD patients and more effective for coagulase-negative Staphylococci related CRBSI.

Conclusions:

  • Combined uPA and antibiotics effectively eradicate coagulase-negative S. epidermidis biofilms in vitro.
  • uPA-based ABL is a safe and effective therapeutic option for CRBSI in HD patients, outperforming heparin-based ABL.
Abstract

Keywords:
Antibiotic-lock solutionsBiofilmCatheter-related blood stream infectionHemodialysis catheterUrokinase

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