Abstract 174

It is well established that infective endocarditis (IE) involving the HACEK (Hemophilus, Actinobaccillus, Cardiobacter, Eikenella, Kingella) group of microbes occurs in patients with congenital heart defects (CHD) and in those with prosthetic grafts. Dental caries and gingival disease have been presumed to be the focus of microbial shedding. The purpose of this study was to determine if children with CHD had a more severe gingival inflammatory condition and harbored the HACEK group of microbes to a greater extent than normal children. METHODS: Two groups of 12 age and sex matched children were selected for this study. The experimental group consisted of twelve children with CHD (4 cyanotic, 8 acyanotic) 1-1/2 to 8 years of age (ave=3.4 years). The control group consisted of twelve healthy children 2 to 8 years of age (ave=3.6 years). No child was taking antimicrobials and no child with CHD was immunodeficient. Each child had a gingival index score recorded as described by Massler. Subgingival cultures were obtained with a sterile paper point in two different areas with the greatest gingival inflammation. Children with CHD had the gingival score and cultures obtained prior to operation with intravenous antibiotic coverage as recommended by the American Heart Association. Gingival samples were cultured for HACEK microbes, total streptococcus (spp) and total actinomycetes (spp) using standard techniques. Chi-square statistics was performed with significance defined at P<0.05. RESULTS: Children with CHD had a more severe gingival inflammatory index (ave=4.4) than the control group (ave=1.5) (P<0.05). 8/12 CHD patients had Actinobacillus actinomycetemcomitans (A.a.) (aveCFU=6.9×103) as compared with 2/12 controls (P<0.05). Furthermore, all cyanotic CHD patients (4/4) had A.a. whereas only 2/12 controls did (P<0.05). 4/12 CHD patients harbored Eikenella corrodens (E) (aveCFU=5.3×103) compared to 1/12 controls (N.S.). There was no significant difference in colonization with E or A.a. between cyanotic or acyanotic patients. No significant differences in total streptococcus (spp) or actinomycetes (spp) were found between CHD patients and controls. CONCLUSIONS: This study suggests that children with CHD have a more severe gingival condition and are colonized with specific HACEK microbes more so than normal children. Children with CHD and gingival inflammation may be at an increased risk for IE, and if this is confirmed in larger studies, may suggest a change in IE prophylaxis regimens.