Reducing central line-associated bloodstream infections in pediatric intestinal failure
Abstract:
Objectives: Due to their dependence on parenteral nutrition, patients with intestinal failure (IF) are at an increased risk of central line-associated blood stream infections (CLABSIs). Ethanol lock therapies (ELTs) reduce the incidence of CLABSIs, but ELTs work locally in the line and have limited availability in the United States. Rifaximin is a non-absorbed, enteral antibiotic used to manage small intestinal bacterial overgrowth (SIBO). Our primary objective was to evaluate the effectiveness of rifaximin to prevent CLABSIs in pediatric IF patients.
Methods: This was a retrospective cohort study of patients with IF managed at a single pediatric center between January 2010 and December 2022. Patients in the cohort had at least 1 CLABSI prior to initiation of rifaximin. Data were collected for 12 months pre- and post-rifaximin initiation. CLABSI incidences were compared using Poisson regression with a log transformation.
Results: Thirty-three patients were included. The observed incidence of CLABSI for all patients in our sample, before and after rifaximin initiation, was 10.2 (8.2, 12.7) and 7.3 (5.8, 9.2) per 1000 central line days, respectively, p = 0.03. Subgroup analysis showed patients who received rifaximin without ELT had signification reduction in CLABSIs, 8.3 versus 3.0 (p < 0.001). There were no statistically significant differences in the proportion of gram-positive or gram-negative bacteria or yeast isolated before and after rifaximin.
Conclusions: Children with IF who were treated with rifaximin experienced fewer CLABSI events, suggesting that rifaximin is a viable option for CLABSI prophylaxis in pediatric IF patients.
Reference:
Johnson E, Konicek C, Lamb N, Fishbein J, Jhaveri R, Cohran V. Effectiveness of rifaximin in reducing central line-associated bloodstream infections in pediatric intestinal failure. J Pediatr Gastroenterol Nutr. 2026 Jul 31. doi: 10.1002/jpn3.70522. Epub ahead of print. PMID: 42535493.