Dialysis access as a source of infective endocarditis in dialysis patients

Abstract

The incidence of Infective Endocarditis (IE) is higher in dialysis patients compared to the general population. A major risk factor for IE in this group stems from bacterial invasion during repeated vascular access. Previous studies have shown increased risk of bacteremia in patients with indwelling dialysis catheters compared to permanent vascular access. However, association between the development of IE and the type of dialysis access is unclear. We aimed to examine the associated types of intravascular access and route of infection in dialysis patients who were admitted with infective endocarditis at our center. All patients admitted to Albert Einstein Medical Center in Philadelphia with a diagnosis of infective endocarditis who were on chronic hemodialysis were identified from the hospital database for the period of 1/1/07 to 12/31/18. Modified Duke criteria was used to confirm the diagnosis of infective endocarditis. A total of 96 cases were identified. Of those, 57 patients had an indwelling dialysis catheter while the other 39 had permanent dialysis access. In 82% of patients with dialysis catheters, their dialysis access site was identified as the primary source of infection compared to 30% in those with permanent dialysis access (p<0.001). The number of dialysis catheters placed in the preceding 6 months was strongly associated with endocarditis resulting from the dialysis access site (OR = 3.202, p=0.025). Dialysis catheters are more likely to serve as the source of infection in dialysis patients developing IE compared to permanent dialysis access. Increased awareness of risk of IE associated with dialysis catheters is warranted.

Infective endocarditis with negative blood cultures in patient with end-stage renal disease treated with peritoneal dialysis

“…New onset of abdominal pain, fever, or the appearance of cloudy peritoneal effluent need immediate response [13]. However also the incidence of IE is higher in dialysis patients compared to the general population [14]. The frequency of IE in patients treated with hemodialysis compared with those receiving peritoneal dialysis differ widely, but in both groups it is raised [15].…”

In-Hospital and Long-Term Outcomes of Infective Endocarditis in Chronic Dialysis Patients

“…Univariate analysis revealed a poor in-hospital prognosis in patients with a tunneled cuffed catheter for dialysis access, but after multivariate adjustment, this association was insignificant. The tunneled cuffed catheters were inserted prior to IE, which served as a possible route of bacteria entrance, 13 and all these catheters were definitely removed at the time of IE diagnosis. The possible explanation for the relation between the use of the catheters and higher mortality was that patients who used the catheter as hemodialysis access were generally older and frailer, and usually experienced primary immaturity of the vascular access.…”

Etiological Structure of Infective Endocarditis in Certain Categories of Patients (Literature Review)

“…В работе H. Jeon et al (2020), изучалась взаимосвязь варианта сосудистого доступа (временный/катетер или постоянный доступ) и пути заражения у пациентов, проходящих процедуру ГД, госпитализированных с диагнозом ИЭ (96 человек) [33]. Из них 57 имели постоянный катетер для диализа.…”