P4.45: Infective Endocarditis as a complication of central venous catheters used for Home Parenteral Nutrition: experience from a national Intestinal Failure Centre

Abstract

Listen

Translate article

Introduction:, The management of intestinal failure (IF) requires the safe and sustained delivery of parenteral nutrition (PN) via long-term central venous catheters (CVCs). Infective Endocarditis (IE) is a recognised complication of indwelling CVCs in a number of medical conditions, for example, the incidence of IE was 483 per 100 000 person-years in haemodialysis patients, while it was 6.5 per 100 000 person-years in the general US population. Indeed, recent ESPEN guidelines on the management of acute (type 2) and chronic (type 3) IF highlight IE as a potential complication. However, there are no published data on the incidence and outcomes of IE in patients with IF. Methods: This is an observational study conducted on all patients with type 2 or 3 IF admitted to a national IF Unit between January 2010 and December 2017. Patients with transthoracic(TTE) and/or transoesophageal(TOE) echocardiography evidence of IE were identified from a prospectively maintained IF database and hospital coded procedures. The diagnosis of IE was based upon Modified Duke’s Criteria, with positive blood cultures, together with a characteristic vegetation appearance on echocardiography, in combination with expert cardiology review. Details of organisms, heart valves involved and antibiotics prescribed were extracted from the patient notes, together with appropriate clinical outcomes. Results: 332 of 432 patients with indwelling CVCs admitted during the study period underwent a total of 534 echocardiograms. 513 TTE and 21TOE were performed. 2 patients were diagnosed with IE both involving native aortic valves and both visible on TTE and TOE. One patient (diagnosed with Enterococcus faecalis IE) had type 2 IF at admission from a referring hospital for ongoing treatment for IE with persistent pyrexia, splinter haemorrhages and regurgitant murmur; clinical symptoms resolved with IV Amoxicillin and Gentamicin but valve replacement was required due to severe Aortic Regurgitation. The second patient (Coagulase-negative Staphylococcus with type 3 IF) was admitted with a CRBSI, low grade pyrexia and intermittent rigors and treated with IV vancomycin and currently remains under cardiology follow up pending potential valve replacement. Conclusions: CVC-associated IE is a very rare complication of CVCs implanted for types 2 and 3 IF. However, as noted in our case series, the potential morbidity associated with this condition means that a high index of suspicion should be maintained.