Infective endocarditis in children with chronic intestinal failure

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.