Infective Endocarditis in Patients With Intestinal Failure: Experience From a National Referral Center

Area of Science:

• Medical Research
• Clinical Outcomes
• Infectious Diseases

Background:

• Infective endocarditis (IE) is a known complication of central line-associated bloodstream infections (CLABSI).
• Central venous access devices (CVADs) are crucial for long-term parenteral nutrition (PN) in patients with intestinal failure (IF).
• Limited data exist on the prevalence, characteristics, and outcomes of IE in IF patients with CVADs.

Purpose of the Study:

• To determine the prevalence, characteristics, and outcomes of IE in patients with intestinal failure (IF) requiring central venous access devices (CVADs).
• To assess the incidence of IE as a complication of central line-associated bloodstream infections (CLABSI) in this specific patient population.

Main Methods:

• Retrospective analysis of a prospectively maintained database of patients with IF types 2 and 3.
• Data extracted from case records for patients managed between January 2010 and December 2018.
• Inclusion of 745 patients with IF and CVADs; 282 echocardiograms performed to investigate potential IE.

Main Results:

• Four cases of IE were identified in 782,666 catheter days, indicating a low overall incidence.
• IE incidence was 0.005 per 1000 catheter days overall and higher in acute type 2 IF inpatients (0.048 per 1000 catheter days).
• IE was rare in type 3 IF patients (0.0026 per 1000 outpatient catheter days).

Conclusions:

• Infective endocarditis (IE) is rare in type 3 IF and a rare consequence of CLABSI in inpatient acute type 2 IF.
• Despite rarity, IE carries high mortality and morbidity in this population.
• Routine echocardiography for CLABSI in IF patients may not be warranted unless high IE risk or virulent organisms are present.