title: Infective endocarditis in patients with end-stage renal disease: clinical presentation and outcome.
abstract: BACKGROUND
  Infective endocarditis is a common complication of vascular access in patients undergoing long-term hemodialysis. However, available data are either dated or gathered from small samples. The goal of this study was to investigate the clinical characteristics and outcome of infective endocarditis occurring in patients with end-stage renal disease.
  
  
  METHODS
  Patients were identified by computerized discharge diagnosis and manual chart review at 3 major hospitals in Honolulu, Hawaii. The search covered an 11-year period, through December 2001. Modified Duke criteria were retrospectively applied. Patients fulfilling criteria for definite endocarditis were included in this study.
  
  
  RESULTS
  Forty patients were identified. Average age was 59.4 years, and average duration of hemodialysis before endocarditis was 3.3 years; arteriovenous fistulas were the most commonly used access sites. Predominant organism was Staphylococcus aureus in 20 (50%) of the 40 cases. The mitral valve was affected in 29 cases (73%); aortic and mitral valve endocarditis was seen in 8 cases (20%). Overall in-hospital mortality was 52% (21/40). Patients with an unfavorable outcome more often had fever on admission, fewer negative blood cultures, and bivalvular infective endocarditis, and more often underwent valve replacement surgery. The perioperative mortality in patients undergoing valve replacement was 73% (11/15).
  
  
  CONCLUSIONS
  Mortality of infective endocarditis in patients with end-stage renal disease remains high and has been essentially unchanged during the past decade. If patients require valve replacement surgery, mortality is even higher. A randomized, controlled trial is needed to clarify whether the increased mortality is due solely to more severe disease in patients requiring valve replacement surgery.
authors.affiliation: Department of Internal Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu. c.spies@gmx.net
authors.forename: Christian
authors.initials: C
authors.lastname: Spies
authors.forename: James R
authors.initials: JR
authors.lastname: Madison
authors.forename: Irwin J
authors.initials: IJ
authors.lastname: Schatz
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000382:microbiology / Q000601:surgery; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D016983:Enterococcus / Q000302:isolation & purification; D005260:Female; D005334:Fever / Q000382:microbiology; D006254:Hawaii; D006350:Heart Valve Prosthesis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D008943:Mitral Valve / Q000382:microbiology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D006435:Renal Dialysis; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents