Taurolidine locks associated with fewer pediatric catheter infections, safety remains uncertain

A systematic review and meta-analysis of nine studies involving 1,200 children found that taurolidine-containing catheter lock solutions were associated with a 77% lower incidence rate of catheter-related bloodstream infections than conventional lock solutions. The finding was consistent across five contributing studies, but the evidence remains limited by a small randomized component, varied patient populations, different formulations and insufficient safety data, according to the analysis published in Frontiers in Pharmacology.

Central venous access devices provide essential routes for chemotherapy, parenteral nutrition, medication delivery and blood sampling in children with serious conditions. They also create a route through which microorganisms can enter the bloodstream. Organisms may migrate along the outside of a catheter, contaminate hubs or connectors and form biofilms within the lumen, or reach the catheter from another infectious site. Such infections can prolong hospitalization, require catheter removal and contribute to severe illness in vulnerable patients.

The researchers searched PubMed, Embase, Web of Science and the Cochrane Library for studies published through 13 September 2026. They also checked reference lists of included papers. Nine controlled studies met the eligibility criteria: three randomized controlled trials and six retrospective cohort studies published between 2008 and 2024. The participants included children with cancer or hematological malignancies, those receiving long-term parenteral nutrition, surgical patients, critically ill children and children requiring central access for other medical indications.

The primary outcome was the incidence density of catheter-related bloodstream infection, expressed as episodes per 1,000 catheter-days. This measure differs from central line-associated bloodstream infection, which is a broader surveillance outcome based on the presence of a central line and does not necessarily establish that the catheter was the confirmed source. The review therefore analyzed the two outcomes separately rather than treating them as interchangeable. Random-effects models were used to pool incidence rate ratios for infection density and risk ratios for outcomes such as cumulative infection incidence, catheter removal, thrombosis and adverse events.

Across the five studies reporting catheter-related bloodstream infection rates, taurolidine locks produced a pooled incidence rate ratio of 0.23, with a 95% confidence interval of 0.15–0.36 and no detected statistical heterogeneity. The probability for this association was below 0.00001. A sensitivity analysis that omitted studies one at a time produced estimates between 0.22 and 0.25, with all confidence intervals remaining below 1. Restricting the primary analysis to randomized trials yielded a similar incidence rate ratio of 0.26, although only two trials contributed and the individual estimate for one had a confidence interval that crossed 1.

Six studies also contributed to an analysis of cumulative catheter-related bloodstream infection. The pooled risk ratio was 0.37, with a 95% confidence interval of 0.23–0.61, indicating a lower observed infection incidence among children whose locks contained taurolidine. Moderate heterogeneity was present, however, with an I-squared value of 54%. The analysis combined formulations that were not identical: most used 1.35% taurolidine with 4% sodium citrate, while others used 1.34% taurolidine with citrate, taurolidine with citrate and heparin, or 2% taurolidine alone. Eight studies used heparin as the control and one used saline.

The separate analysis of three studies reporting central line-associated bloodstream infection also favored taurolidine, with an incidence rate ratio of 0.25 and a 95% confidence interval of 0.08–0.85. This result was much less stable. Heterogeneity was 90%, and removing individual studies changed the precision and statistical significance of the pooled estimate. A funnel plot for this outcome also appeared asymmetric, although plots based on only three studies cannot reliably establish publication bias. The reviewers consequently treated the catheter-related infection result as the principal efficacy evidence and the broader surveillance result as complementary but uncertain.

Safety outcomes did not yield statistically significant differences, but the data were too limited to establish comparable safety. Four studies reported catheter removal because of infection, producing a risk ratio of 1.25, with a 95% confidence interval of 0.60–2.62. Two randomized studies contributed data on device-related thrombosis, for which the risk ratio was 0.88 and the confidence interval was 0.29–2.64. Neither estimate supports a conclusion that the risks are equivalent because both intervals were wide. The thrombosis analysis also compared different lock formulations, meaning that any influence from heparin could not be separated from that of taurolidine.

Adverse events were reported in four studies. Their pooled risk ratio was 3.93, with a broad 95% confidence interval of 0.82–18.80 and heterogeneity of 64%; the result did not meet the review’s threshold for statistical significance. Reported events in taurolidine groups included taste disturbances, nausea, vomiting and pain. Because studies did not consistently link these outcomes to individual components of the lock solutions, it is not possible to attribute them specifically to taurolidine rather than citrate, heparin, stabilizers, underlying disease or concomitant treatment. The studies also provided little systematic surveillance of antimicrobial resistance or long-term toxicity.

The evidence base has important limitations. Six of the nine studies were retrospective, making the findings vulnerable to residual confounding, selection bias and changes in catheter-care practice over time. Several samples were small, and follow-up was generally shorter than one year. Patients differed substantially in baseline infection risk, and studies used different catheter types, lock volumes, dwell times, administration schedules and infection definitions. Some studies also included prophylactic antibiotics, but their timing, duration and distribution between groups were not reported consistently. The review itself searched four major databases but did not conduct separate searches of trial registries, conference proceedings or grey literature.

Overall, the analysis supports an association between taurolidine-containing locks and fewer catheter-related bloodstream infections in children requiring central venous access, with the most consistent result obtained for infections attributed to the catheter. The magnitude of absolute benefit cannot be inferred from the relative estimates alone because it depends on baseline infection risk, catheter exposure and follow-up duration. The findings do not establish comparative safety, long-term effects on microbial resistance or equivalence between taurolidine formulations. The authors conclude that larger, multicenter randomized trials with standardized infection definitions, detailed lock protocols, adequate safety monitoring and longer microbiological follow-up are needed before routine implementation can be recommended.

Subject of Research: Pediatric central venous catheter lock solutions for preventing bloodstream infections

Article Title: The efficacy of taurolidine lock solution in preventing catheter-related bloodstream infections in pediatrics: a systematic review and meta-analysis

Article References: Qin, C., Huang, B., Liu, Z., Huang, L., Liao, H., Quan, J., Li, L., Huang, X., & Liang, W. (2026). The efficacy of taurolidine lock solution in preventing catheter-related bloodstream infections in pediatrics: a systematic review and meta-analysis. Frontiers in Pharmacology, 17, Article 1938862. https://doi.org/10.3389/fphar.2026.1938862

Image Credits: AI Generated

DOI: 10.3389/fphar.2026.1938862

Keywords: taurolidine, pediatrics, catheter-related bloodstream infection, central venous access device, catheter lock, systematic review, meta-analysis, patient safety, antimicrobial resistance, efficacy, lock, solution