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 (115.0±51.2 vs 85.9±27.6, P=0.011 and 79.8±45.4 vs 20.5±11.3, P<0.001, respectively) and declined following antibiotic therapy (115.0±51.2 vs 77.9±29.8, P=0.003 and 79.8±45.4 vs 26.2±10.8, P<0.001, respectively). Receiver operating characteristic curves showed that neither sTREM-1 nor LBP is sufficient to predict bacteremia versus fever without bacteremia (area under these curves=0.57 and 0.82, respectively). Baseline LBP was higher in hospitalized patients than in outpatients (27.5±8.7 vs 13.5±9.2, P=0.002), patients with previous BSIs versus those without (23.5±10.4 vs 10.1±8.3, P=0.016), and those listed for transplantation versus those not listed (29.6±9.8 vs 16.2±9.5, P=0.033). 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. Copyright © 2011 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.