Background: The use of indwelling Central Venous Access Devices (CVADs) is associated
with the development of bloodstream infections. When CVADs are used to administer systemic
antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing
Clostridium difficile infection. The overall bloodstream infection rate is estimated to be
around 1.74 per 1000 Central Venous Catheter (CVC)-days.
Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine
(cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via
Method: A small case series is described of adult patients who received regular intravenous antibiotic
treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this
represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C.
difficile infection, during the course of the intravenous antibiotic treatment the patients also received
daily oral supplementation with 4 g colestyramine.
Results: There were no untoward infectious events. In particular, none of the patients developed any
symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection
would have been expected.
Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection
through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are
able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody
responses to TcdA and TcdB have been shown to induce protection against C. difficile infection