Background: Patients with intestinal failure (IF) are dependent on parenteral nutrition (PN) for growth and survival, however are at high risk of central line associated bloodstream infections (CLABSI) and line complications, resulting in significant morbidity and mortality. 70% ethanol locks have been used for the treatment and prevention of CLABSI with success but reported issues relate to product availability and catheter patency. KiteLock 4%, an EDTA solution, is an effective non-antibiotic antimicrobial, anti-biofilm and anticoagulant agent shown to significantly eradicate clinically relevant microorganisms by 87% within central venous access devices. Adult studies have demonstrated efficacy of EDTA in CLABSI reduction, however there remains a deficit of pediatric data. Our objective was to determine Kitelock efficacy in the prevention of CLABSIs and reduction in line occlusions in pediatric IF patients on long-term PN.

Methods: We conducted a retrospective cohort study of patients managed by IF programs at 2 tertiary Canadian pediatric centres between April 1, 2016 to December 31, 2018 who received Kitelock. Data was collected for 12 months prior to and following initiation of Kitelock. CLABSIs, line replacements and use of alteplase (per 1000 catheter days) before and after initiation of KiteLock were compared using a Wilcoxon matched-pairs signed-ranks test. Data was reported as medians (interquartile ranges) and frequencies (proportions).

Results: Twenty patients (10 girls; median age 83 months [range, 8-232 months]) began KiteLockâ for recurrent infections or sluggish/occluded line. The rate of CLABSI prior to starting KiteLock was 2.7(0-4.0) per 1000 catheter days. Patients received KiteLock for a median of 365 (278-365) days with no infections in the 12 months following commencement of KiteLockâ (p=0.002). Median rates of occlusive episodes for the entire cohort prior to starting KiteLock were 0 (0-5.0) in the 12 months prior to starting KiteLock and 0 (0-2.0) after starting therapy (p=0.018). In patients with occlusions (n=9), the median rate of alteplase use prior to starting Kitelock was 5.5 episodes (2.7-19.2) compared to 2.7 episodes (0-2.7) (p=0.018)

Conclusions: Results demonstrate a significant decrease in CLABSI with KiteLock and a reduction in catheter occlusions. Our preliminary findings suggest KiteLock is effective in reducing CLABSI and catheter occlusions in pediatric patients with long-term central access requirements.