The Use of Taurolidine as an Adjunctive Treatment to Reduce Recurrent Peritonitis in Peritoneal Dialysis Patients

Abstract

Background and objective Peritoneal dialysis (PD) represents a cornerstone in the management of end-stage kidney disease (ESKD), offering patients greater autonomy, better preservation of residual renal function, and improved cardiovascular outcomes compared to hemodialysis. However, the technique's long-term viability is frequently threatened by peritonitis - a complication associated with substantial morbidity, technique failure, and transition to hemodialysis. Among these, recurrent peritonitis is defined as an episode caused by the same organism within four weeks after completion of antibiotic therapy. Taurolidine, a taurine-derived molecule with broad-spectrum bactericidal, fungicidal, and anti-biofilm activity, has demonstrated efficacy in preventing central venous catheter-related infections in hemodialysis patients. Its use in PD remains limited but potentially promising, particularly in the context of biofilm-associated peritonitis. This study aimed to evaluate the safety, feasibility, and clinical efficacy of taurolidine-urokinase lock therapy (TauroLock™-U25,000) in PD patients experiencing recurrent or culture-negative peritonitis, especially those refractory to conventional antibiotic regimens. Methods We retrospectively analyzed 13 patients treated at our nephrology centre between 2022 and 2024. Eligible cases included those with recurrent or persistent peritonitis with multidrug-resistant (MDR) organisms or negative cultures suggestive of intraluminal biofilm. Patients underwent three instillations of TauroLock™-U25,000 over 21 days, in combination with standard intraperitoneal antibiotics. Outcomes included clinical resolution, microbiological eradication, recurrence, and adverse events. Results All patients completed the protocol without requiring catheter removal. Pathogens included Pseudomonas sp., Staphylococcus aureus, Escherichia coli, Klebsiella sp., Stenotrophomonas maltophilia, and others commonly associated with poor prognoses in PD peritonitis. Two cases were culture-negative. Clinical and microbiological resolution was achieved in 100% of patients, with no relapses during follow-up. Mild, transient abdominal discomfort occurred in eight patients but resolved spontaneously. Conclusions Taurolidine-urokinase lock therapy appears to be a viable and safe therapeutic option in the management of peritonitis in PD patients, particularly in those with biofilm-associated or MDR infections. Its favorable tolerability, previously demonstrated in the hemodialysis setting, and the growing evidence of efficacy in PD suggest a potential paradigm shift in catheter-sparing strategies. Further prospective trials are essential to confirm these results and standardize treatment protocols.

Keywords: biofilm; catheter lock therapy; dialysis-associated infections; multidrug-resistant organisms; peritoneal dialysis; recurrent peritonitis; taurolidine; urokinase.