RESUMEN
OBJECTIVE: Central venous catheter-associated bloodstream infections (CVC-BSIs) are a major cause of morbidity and mortality in the pediatric intestinal failure (IF) population. We assessed plasma lipopolysaccharide-binding protein (LBP) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as biomarkers for CVC-BSI. We hypothesized that sTREM-1 and LBP rise with BSI and decline following treatment, and that baseline LBP is higher in the IF population than in controls. PATIENTS AND METHODS: Patients younger than 4 years were recruited from the IF registry at Cincinnati Children's Hospital. LBP and sTREM-1 levels were measured on 22 patients with IF at baseline, 17 patients with IF with BSIs, and 11 healthy controls. RESULTS: Mean sTREM-1 level (pg/mL) and LBP level (µg/mL) rose with CVC-BSI over baseline (115.0â±â51.2 vs 85.9â±â27.6, Pâ=â0.011 and 79.8â±â45.4 vs 20.5â±â11.3, Pâ<â0.001, respectively) and declined following antibiotic therapy (115.0â±â51.2 vs 77.9â±â29.8, Pâ=â0.003 and 79.8â±â45.4 vs 26.2â±â10.8, Pâ<â0.001, respectively). Receiver operating characteristic curves showed that neither sTREM-1 nor LBP is sufficient to predict bacteremia versus fever without bacteremia (area under these curvesâ=â0.57 and 0.82, respectively). Baseline LBP was higher in hospitalized patients than in outpatients (27.5â±â8.7 vs 13.5â±â9.2, Pâ=â0.002), patients with previous BSIs versus those without (23.5â±â10.4 vs 10.1â±â8.3, Pâ=â0.016), and those listed for transplantation versus those not listed (29.6â±â9.8 vs 16.2â±â9.5, Pâ=â0.033). CONCLUSIONS: sTREM-1 and LBP rise with CVC-BSI in IF and decline after treatment; however, neither distinguishes infection from nonbacteremic febrile episodes. Baseline LBP may be a marker of disease severity in IF.