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Infective endocarditis in children with chronic intestinal failure
Divya Pandey1, Veena Logarajah1, Lay Queen Ng1
1Gastroenterology, Hepatology & Nutrition, Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
Insights
Infective endocarditis (IE) is a rare risk in children with intestinal failure (IF) requiring parenteral nutrition (PN). Early cardiac surveillance is recommended for high-risk pediatric IF patients to ensure timely diagnosis and intervention.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Gastroenterology
Background:
- Infective endocarditis (IE) is a serious complication in pediatric patients with chronic intestinal failure (IF).
- Patients with IF often require long-term parenteral nutrition (PN) via central venous access devices (CVADs), increasing IE risk.
- This study investigates IE incidence, clinical features, and outcomes in children with IF at a single institution.
Purpose of the Study:
- To determine the incidence of infective endocarditis (IE) in pediatric patients with chronic intestinal failure (IF) dependent on long-term parenteral nutrition (PN).
- To describe the clinical features and outcomes of IE in this high-risk pediatric population.
- To evaluate the association between IE and factors such as catheter duration, bloodstream infections, and venous thrombosis.
Main Methods:
- A retrospective descriptive study was conducted on pediatric patients (0-18 years) with chronic IF requiring PN for over 60 days between 2013 and 2024.
- Infective endocarditis (IE) diagnosis was confirmed using modified Duke criteria.
- Data on patient characteristics, IE episodes, treatment, and outcomes were collected and analyzed.
Main Results:
- Five IE episodes occurred in 4 out of 29 pediatric IF patients, with an overall incidence of 0.144 per 1000 catheter days.
- Patients with IE had significantly longer catheter durations, more central line-associated bloodstream infections, and a higher prevalence of catheter-related venous thrombosis compared to those without IE.
- All IE cases resolved with antimicrobial therapy; outcomes included one death from complications, one patient achieving enteral autonomy, and two successful intestinal transplantations.
Conclusions:
- Infective endocarditis (IE), though uncommon, presents significant risks for pediatric patients with intestinal failure (IF).
- Factors such as prolonged central venous access device (CVAD) use, central line-associated bloodstream infections, and venous thrombosis are associated with IE in this population.
- Early cardiac surveillance in high-risk pediatric IF patients is crucial for timely diagnosis and intervention, potentially improving outcomes.
Background:
Infective endocarditis (IE) is a rare but serious complication in pediatric patients with chronic intestinal failure (IF) dependent on long-term parenteral nutrition (PN) via central venous access devices (CVADs). This study aimed to investigate the incidence, clinical features and outcomes of IE in children with chronic IF at a single institution.
Methods:
A retrospective descriptive study was conducted in pediatric patients (0-18 years) with chronic IF requiring PN for > 60 days during 2013-2024. IE was diagnosed using modified Duke criteria.
Results:
Five IE episodes occurred in 4 patients out of 29 with chronic IF (median follow-up 9 years). The overall incidence was 0.144 per 1000 catheter days (5155.2 per 100,000 person-years). Compared with patients without IE, those with IE had longer catheter durations (median 2941.5 vs. 443.0 days, p = 0.006); more central line-associated bloodstream infections (median 8 vs. 1, p = 0.0015); higher prevalence of catheter-related venous thrombosis (100 % vs. 12 %, p = 0.001); and were more likely to have dysmotility (75 % vs. 16 %, p = 0.02). IE resolved with antimicrobial therapy in all cases. During a median follow-up of 2.2 years, one patient died from superior vena cava obstruction, sepsis and multiorgan failure while awaiting transplantation; one achieved enteral autonomy and was weaned off PN; and two underwent successful intestinal transplantation.
Conclusions:
Though uncommon, IE poses significant risks in pediatric IF; early cardiac surveillance in high-risk patients may facilitate timely diagnosis and intervention.
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