Infective endocarditis in chronic haemodialysis: two treatment strategies.
BACKGROUND
Infective endocarditis (IE) is more frequent in patients on chronic haemodialysis (CHD) than in the general population and vascular access is the more frequent identified port of its entry. According to experimental and clinical studies the vascular access may also interfere with the treatment of IE. To improve the treatment of IE in CHD, patients were temporarily switched to peritoneal dialysis (PD) after the removal of the vascular access. In this preliminary report the outcome of IE in those CHD patients switched to PD is compared with the outcome in IE patients who remained on CHD.


METHODS
All cases of IE that occurred during a 5 year period were retrospectively analysed. The Duke criteria for IE were used for diagnosis. All patients underwent transoesophageal echocardiography. All patients were treated with the same schedule of antibiotic treatment. The vascular access of a patient was removed when it was judged to be the source of infection.


RESULTS
Twenty-one patients were studied. Twelve patients had been temporarily switched to PD after the diagnosis of IE and nine patients had remained on CHD treatment. There were not statistically significant differences between the two groups with respect to demographic data, comorbid diseases and the frequency of Staphylococcus aureus as the causative germ. In-hospital mortality was 8.3% in patients switched to PD and 55.5% in patients maintained on HD (P: 0.03).


CONCLUSIONS
The data presented here suggest that the high mortality of IE in CHD patients may also be associated with the vascular access necessary for HD. If these results are confirmed by prospective studies with higher numbers of patients, PD could turn out to have a place in the treatment of IE in CHD patients.
Fernández-Cean
Juan
J
Centro de Nefrología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay. jcean@hc.edu.uy
Alvarez
Asunción
A
Burguez
Sergio
S
Baldovinos
Graciela
G
Larre-Borges
Patricia
P
Cha
Mercedes
M
D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D006435:Renal Dialysis / Q000009:adverse effects*; D019233:Retreatment; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D013211:Staphylococcus aureus; D013212:Staphylococcus epidermidis; D013997:Time Factors