The CATERPILLAR study

Background

Tunneled central venous access devices (CVAD) are fundamental in pediatric oncology for long-term venous access. The rate of central line-associated bloodstream infections (CLABSI) in this patient group is high, which results in high morbidity. CLABSIs are seen in at least 30% of the children with a CVAD, 17% of the inserted CVADs are removed early and 5% of the patients are admitted at an intensive care unit due to CLABSIs. In literature, TauroLock-Hep100 is suggested as the most promising and safe method for the prevention of CLABSIs. TauroLock-Hep100 has anticoagulant and antimicrobial properties without reported microbial resistance. Currently, in the standard of care of pediatric oncology patients in the Netherlands, the heparin lock is used, which only has anticoagulant properties. An open labelled randomized controlled trial will be performed to study efficacy and safety of TauroLock-Hep100 in pediatric oncology patients for the prevention of CLABSIs. 

Aims

The aim of this study is to increase quality of life for children with cancer by reducing the CLABSI-rate, CVAD-removal rate, dispense of antibiotics, days of hospital/intensive care unit admission, and morbidity/mortality rate due to CLABSI.

Project Outcomes

• van den Bosch CH, Loeffen Y, van der Steeg AFW, van der Bruggen JT, Frakking FNJ, Fiocco M, van de Ven CP, Wijnen MHWA, van de Wetering MD (2024). The CATERPILLAR-study: An assessor blinded randomized controlled trial comparing a taurolidine-citrate-heparin lock solution to a heparin-only lock solution for the prevention of central-line associated bloodstream infections in paediatric oncology patients. J Hosp Infect, S0195-6701(24)00228-7. doi: 10.1016/j.jhin.2024.06.009.

• van den Bosch CH*, Kops AL*, Loeffen YGT, van der Steeg AFW, van de Wetering MD, Fiocco M, Ekkelenkamp MB, Wolfs TFW (2024). Central venous catheter-related bloodstream infections caused by Enterobacterales in paediatric oncology patients; catheter salvage or removal. Pediatr Infect Dis J, 43(1):49-55. doi: 10.1097/INF.0000000000004106

• van den Bosch CH, Loeffen Y, van der Steeg AFW, van der Bruggen JT, Frakking FNJ, Fiocco M, van de Ven CP, Wijnen MHWA, van de Wetering MD (2023). CATERPILLAR-study protocol: an assessor-blinded randomised controlled trial comparing taurolidine-citrate-heparin to heparin-only lock solutions for the prevention of central line-associated bloodstream infections in paediatric oncology patients. BMJ Open, 13(3):e069760. doi: 10.1136/bmjopen-2022-069760

• van den Bosch CH, Spijkerman J, Wijnen MHWA, Hovinga ICLK, Meyer-Wentrup FAG, van der Steeg AFW, van de Wetering MD, Fiocco M, Morsing IE, Beishuizen A (2022). Central venous catheter-associated complications in paediatric patients diagnosed with Hodgkin lymphoma: implications for catheter choice. Support Care Cancer, 30(10):8069-8079. doi: 10.1007/s00520-022-07256-3

• van den Bosch CH, Jeremiasse B, van der Bruggen JT, Frakking FNJ, Loeffen YGT, van de Ven CP, van der Steeg AFW, Fiocco M, van de Wetering MD, Wijnen MHWA (2022). The efficacy of taurolidine containing lock solutions for the prevention of central-venous-catheter-related bloodstream infections: a systematic review and meta-analysis. J Hosp Infect, 123:143-155. doi: 10.1016/j.jhin.2021.10.022

• van den Bosch CH, van der Bruggen JT, Frakking FNJ, Terwisscha van Scheltinga CEJ, van de Ven CP, van Grotel M, Wellens LM, Loeffen YGT, Fiocco M, Wijnen MHWA (2019). Incidence, severity and outcome of central line related complications in pediatric oncology patients: A single center study. J Pediatr Surg, 54(9):1894-1900. doi: 10.1016/j.jpedsurg.2018.10.054

Team

• Drs. C. van den Bosh, PhD candidate at the Princess Maxima Center for Pediatric Oncology

• Prof. dr. M. Fiocco, Mathematical Institute Leiden University, Department of Biomedical Data Sciences Leiden University Medical Center & Princess Máxima Center for Pediatric Oncology

• Drs. C.P. van de Ven, Pediatric Surgeon at the Princess Maxima Center for Pediatric Oncology

• Dr. M.D. van de Wetering, Pediatric Oncologist at the Princess Maxima Center for Pediatric Oncology

• Prof. dr. M.H.W.A. Wijnen, Pediatric Surgeon at the Princess Maxima Center for Pediatric Oncology