Abstract 1028 Poster Session IV, Tuesday, 5/4 (poster 164)

Bacterial endocarditis (BE) is an uncommon disease in infants < 6 months (mos) of age. Enterococcus is a very rare etiologic agent of BE in this age group, with almost no reports in the published literature. We identified 4 infants < 6 mos of age with enterococcal endocarditis from 79 patients (pts) treated for BE between 1980-1998 at Children's Memorial Hospital and describe the clinical characteristics, management and outcome of these pts. Diagnosis (dx) was based on the Duke Criteria for BE, microbiologic, and echocardiographic findings. All 4 pts were diagnosed in 1997-1998. Three of the pts were male; 50% of the pts were white and 50% were Hispanic. Mean (M) age of the pts was 2.08 mos (range-R 0.30-4.25). All pts had underlying congenital cardiac disease; 2 pts also had chromosomal abnormalities. Common symptoms on presentation were fever (75%), decreased activity (50%), GI symptoms (50%), increased work of breathing (100%) and irritability (100%). Mean duration of fever prior to dx was 4 days (d) (R 2-7 d). Selected characteristics of the pts are as follows: (Table) Common physical findings were fever (75%), congestive heart failure (50%), hepatosplenomegaly (25%), and presence of a new heart murmur (25%). Median (med) WBC count on admission 8.25 x 103/mm3 (R 7.2-14.1). M duration of fever after initiation of antibiotics (Abx) 2.25d (R 0-4d). M duration of (+) blood cultures (BC) before Abx 2.25d (med 2d, R 1-3d).M duration of (+) BC after initiation of Abx 2.75d (med 2d, R 1-6d). M duration of fever after sterilization of BC 1.75d (med 2d, R 1-3d). The ampicillin (amp) MIC was 0.5-1.0 µg/mL and the vancomycin (vanc) MIC was < 2.0 µg/mL for all the isolates; none of the isolates were gentamicin (gent) resistant. All pts had additional risk factors for BE; 3 of the pts had a history of (HO) cardiac surgery within 2.5 mos prior to developing BE, and all had a HO umbilical catheters and/or central venous catheters. All pts with HO cardiac surgery had prosthetic material in place and were treated successfully for their BE without removal of this material. The most common Abx regimens were amp or vanc plus gent. Duration of Abx therapy for all pts was 6-8 weeks. All pts recovered from their BE. This represents the largest descriptive clinical database for infants < 6 mos of age with enterococcal endocarditis.

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