title: Granulicatella bacteraemia in children: two cases and review of the literature.
abstract: BACKGROUND
  Granulicatella spp. is a fastidious bacteria responsible for bacteremia and endocarditis which are fatal in about 20% of the cases. These severe infections are uncommon in children under 17 years of age and have proven extremely difficult to treat.
  
  
  METHODS
  We report a brief review of the literature and two cases of NVS bacteremia by Granulicatella complicated by infective endocarditis (IE). The first one is that of a 7-year-old Caucasian female with Shone syndrome and IE involving the pulmonary valve homograft, confirmed by echocardiography. The second case is that of a 5-year-old Caucasian male. In this patient echocardiogram was negative for signs of IE; however, a "possible" IE was suspected on the basis of a cardiac catheterization 3 weeks before the onset of fever. Since in both our patients clinical failure of first line antibiotic treatment was observed, we used a combination of meropenem with another anti-streptococcal drug with excellent results.
  
  
  CONCLUSIONS
  In Granulicatella bacteremia in the pediatric population, combination antimicrobial therapy including meropenem should be considered as a second line treatment in non-responding patients.
authors.affiliation: Unit of Immunology and Infectious Disease, University Hospital Pediatric Department, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, Rome, Italy. maiadeluca@gmail.com
authors.forename: Maia
authors.initials: M
authors.lastname: De Luca
authors.forename: Donato
authors.initials: D
authors.lastname: Amodio
authors.forename: Sara
authors.initials: S
authors.lastname: Chiurchiù
authors.forename: Maria Assunta
authors.initials: MA
authors.lastname: Castelluzzo
authors.forename: Gabriele
authors.initials: G
authors.lastname: Rinelli
authors.forename: Paola
authors.initials: P
authors.lastname: Bernaschi
authors.forename: Francesca Ippolita
authors.initials: FI
authors.lastname: Calò Carducci
authors.forename: Patrizia
authors.initials: P
authors.lastname: D'Argenio
mesh_terms: D016470:Bacteremia / Q000150:complications / Q000175:diagnosis*; D056568:Carnobacteriaceae / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male