Epidemiology and outcome of infective endocarditis in hemodialysis patients.
BACKGROUND
Survival in patients with infective endocarditis (IE) ranges from 4 to 50% depending on the type of organism, the type of valve involvement and the type of treatment.


METHODS
We conducted a retrospective analysis of data in hemodialysis (HD) patients at our center from 1990 to 2000. Demographics, risk factors, and outcome data were extracted in the subgroup of patients with first-episode IE diagnosed primarily by echocardiography.


RESULTS
A total of 2239 patients underwent HD at our center. Thirty-two (1.4%) had IE defined using the Duke Criteria. Permanent and temporary venous dialysis catheters, arteriovenous (AV) grafts, and AV fistulae were used in 19 (59%), 12 (38%), and 1 (3%) patient respectively. Mean access duration was 7.6 +/- 7.9 months. Thirty (94%) patients had positive blood cultures, with the majority having Staphylococcus aureus bacteremia. Two (7%) patients had positive echocardiographic findings but negative blood cultures due to the commencement of empiric antibiotic therapy prior to blood cultures. The mitral valve was mainly affected. Transesophageal echocardiography was performed in 23 (72%) patients and detected an intracardiac mass in all 23 patients. One-year mortality was 56.3%. A poor 1-year prognosis was associated with presenting features of low hemoglobin, elevated leukocyte count, hypoalbuminemia, severe aortic and mitral regurgitation, and annular calcification in mitral valve IE.


CONCLUSIONS
The prevalence of IE in HD patients is 1.4%. One-year mortality was 56.3%. Close observation is required during the first year when patients with severe valvular regurgitation and hematological abnormalities have a high mortality.
Maraj
Suraj
S
Division of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA. marajs@einstein.edu
Jacobs
Larry E
LE
Kung
Shiang-Cheng
SC
Raja
Rasib
R
Krishnasamy
Prakash
P
Maraj
Rajiv
R
Braitman
Leonard E
LE
Kotler
Morris N
MN
D000208:Acute Disease; D000328:Adult; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003710:Demography; D024881:Drug Resistance, Bacterial; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome