Infective endocarditis in dialysis patients: New challenges and old

Abstract

This is the largest reported confirmed IE series in dialysis patients. Infective endocarditis in HD patients remains a challenging problem-although hemoaccess via dual-lumen catheters remains a significant risk, many cases developed in patients with AVFs and this group suffered the greatest mortality. An abnormal valve (frequently calcified) was another risk factor; because valve calcification is now common after 5 years on dialysis, more effort in preventing this avoidable form of ectopic calcification may reduce the risk of developing IE.

Excellent Prognosis of Culture Negative Endocarditis in Hemodialysis Patients: A Case Series

“…[9][10][11] Fever occurred in 100% and a new heart murmur occurred in four of five cases in this series (see Table 1). This is in accord with clinical features reported by other authors.…”

“…Second, S. aureus is the most frequently isolated pathogen in dialysis patients with IE, and the mortality rate secondary to S. aureus IE is high. [9,14,16,17] Third, according to microbiology patterns observed in our own institution, 62% of all S. aureus isolated are methicillin-resistant, and these patients require a thrice-weekly dialysis in a hospital facility; thus, the occurrence of MRSA bacteremia may represent a true nosocomial infection carrying a devastating virulence in an immune dysregulated uremic host. [18][19][20] The mortality rate of CNE in the general population ranges from 7-32% [12,13] ; the outcome is even less optimistic in endocarditis patients with true negative blood culture than in patients with previous antibiotics treatment.…”

A case of histopathologically confirmed infective endocarditis with no vegetations observed during preoperative diagnosis

“…The mortality rate for IE among HD patients is relatively high: approximately 30 % within 30 days of hospitalization in patients with poor prognosis [1]. Here, we report a case in which vegetations were not observed during the preoperative diagnosis, but where a definitive diagnosis of IE was made histopathologically.…”

“…As such, for immunocompromised ESRD patients, the treatment of infectious diseases is crucial. The relative risk of IE is high in HD patients [1]. HD patients are prone to developing calcification of the valve [3], and the incidence of valve replacements is high [4].…”

“…The relative risk of infective endocarditis (IE) is as high as 16.9 in hemodialysis (HD) patients compared with the general population, as valve calcification caused by abnormal calcium-phosphorus metabolism induces valve abnormalities, vascular access is available, and immune function is compromised due to renal failure [1]. The mortality rate for IE among HD patients is relatively high: approximately 30 % within 30 days of hospitalization in patients with poor prognosis [1].…”