Epidemiology and clinical outcomes of infective endocarditis in hemodialysis patients.
BACKGROUND
Infective endocarditis is one of the most serious complications of bacteremia in patients undergoing chronic hemodialysis and is more frequent than previously recognized. The aim of our study was to describe the clinical characteristics, outcome, and factors predicting mortality of infective endocarditis in hemodialysis patients.


METHODS
In this retrospective review, all patients on chronic hemodialysis admitted to a 600-bed urban teaching hospital with infective endocarditis over a 15-year period (1990 to 2004), were identified using discharge codes. Modified Duke criteria were retrospectively applied, and patients fulfilling the criteria for definite endocarditis were included in the study.


RESULTS
Sixty-nine patients on hemodialysis with definite endocarditis were identified. The predominant type of vascular access was double-lumen catheter (66.7%). The mean duration of dialysis was 37 +/- 32 months. The predominant organism was Staphylococcus aureus (57.9%), of which 57.5% were methicillin susceptible. The most frequently infected valve was mitral (49.3%), followed by aortic (21.7%) and tricuspid (10.1%) valves. The cardiac and neurologic complication rates were 40.6% and 37.7%, respectively. Fifteen patients underwent valvular heart surgery. The overall in-hospital mortality was 49.3% (34 of 69). More patients who had surgery survived than patients who did not (12 of 15 versus 23 of 54; p = 0.018, odds ratio = 5.39, 95% confidence interval: 1.3 to 17.6). On logistic regression, valve surgery was the only independent factor predicting survival (p = 0.023).


CONCLUSIONS
The prognosis of infective endocarditis in hemodialysis patients is poor, with surgery serving as an independent predictor of survival.
Kamalakannan
Desikan
D
St. John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, Michigan 48236, USA. desikan.kamalakannan@stjohn.org
Pai
Rama Manohara
RM
Johnson
Leonard B
LB
Gardin
Julius M
JM
Saravolatz
Louis D
LD
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006784:Hospitals, Teaching; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014505:Urban Population
D000900:Anti-Bacterial Agents