2258. Infections During the First Year of Life are Associated with Increased Morbidity and Mortality in Patients with Single Ventricle (SV) Physiology at Texas Children's Hospital (TCH) 
Session: Poster Abstract Session: Pediatric Potpourri
Saturday, October 29, 2016
Room: Poster Hall
  • Erin Kritz IDSA Poster FINAL.pdf (1.6 MB)
  • Background: Children with SV physiology require prolonged hospitalizations and multiple surgeries during their first year of life. There are limited data on the incidence of infections and associated outcomes in these patients. The objective of this study was to characterize the microbiology, associated risk factors, and clinical outcomes of SV patients at TCH during their first year of life.

    Methods: We completed a retrospective chart review of infants with SV physiology born between 12/2009 and 4/2015.

    Results: Of the 127 infants with SV physiology 64% had hypoplastic left heart syndrome, 16% unbalanced atrioventricular canal, 12% double outlet right ventricle, 6% Shone's complex, and 2% double inlet left ventricle. Sixty-nine patients (54%) were male. 124 patients (98%) underwent stage one palliation and 99 (78%) underwent stage two palliation. All cause mortality was 23%.

    Thirty patients (24%) had at least one viral infection during the first year of life. Thirty-two viruses were identified: rhinovirus/enterovirus (12), RSV (7), parainfluenza virus (4), adenovirus (3), influenza (3), CMV (2), and HMPV. Twenty-four (75%) viral infections were community-acquired; 8 were nosocomial. Infants with viral infections were more likely to have unplanned admissions (67% vs. 38%, p < 0.01).

    Sixty-one patients (48%) had 96 positive bacterial cultures during the first year of life; 93 (97%) were nosocomial. 143 organisms were identified from the blood (52), respiratory tract (44), urinary tract (24), wound (18), peritoneal fluid (3), and stool (2). The most common organisms were coagulase negative staphylococci (25), Enterobacter species (24), Escherichia coli(16), Klebsiella species (15), and Pseudomonas aeruginosa (15). Infants with bacterial infections had a longer length of stay (LOS) during their initial admission (105 + 70 vs. 49 + 37 days, p <0.01) and longer ICU LOS (71 + 69 vs 29 + 46 days, p<0.01). They also had higher rates of mortality by one year (p<0.01) and were more likely to require extracorporeal membrane oxygenation support (p=0.02).

    Conclusion: Children with SV physiology have frequent infections, which are associated with increased morbidity and mortality. These data support the need for improved strategies to prevent infections in this vulnerable population.

    Erin Kritz, DO, Pediatric Critical Care, Baylor College of Medicine, Houston, TX, Claire Bocchini, MD, Pediatric Infectious Disease, Baylor College of Medicine, Houston, TX and Elena Ocampo, MD, Pediatric Cardiology, Baylor College of Medicine, Houston, TX


    E. Kritz, None

    C. Bocchini, None

    E. Ocampo, None

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