Infective endocarditis in children with chronic intestinal failure

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.