title: Diagnosis and treatment of infective endocarditis in chronic hemodialysis patients.
abstract: OBJECTIVE
  To analyze the clinical features of hemodialysis patients complicated by infective endo carditis.
  
  
  METHODS
  The clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis.
  
  
  RESULTS
  The average age of the six patients was 52.3 +/- 19.3 years old. Four were males. Vascular accesses at the onset of infective endocarditis were as follows: permanent catheters in three, temporary catheters in two, and arteriovenous fistula in one. Three were found with mitral valve involvement, two with aortic valve involvement, and one with both. Five vegetations were found by transthoracic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialysis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure after further hemodialysis for three months. One was well on maintenance hemodialysis for three months after surgery.
  
  
  CONCLUSIONS
  Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings. With catheters removed, full course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective endocarditis.
authors.affiliation: Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
authors.forename: Jian-Ling
authors.initials: JL
authors.lastname: Tao
authors.forename: Jie
authors.initials: J
authors.lastname: Ma
authors.forename: Guang-Li
authors.initials: GL
authors.lastname: Ge
authors.forename: Li-Meng
authors.initials: LM
authors.lastname: Chen
authors.forename: Hang
authors.initials: H
authors.lastname: Li
authors.forename: Bao-Tong
authors.initials: BT
authors.lastname: Zhou
authors.forename: Yang
authors.initials: Y
authors.lastname: Sun
authors.forename: Wen-Ling
authors.initials: WL
authors.lastname: Yea
authors.forename: Qi
authors.initials: Q
authors.lastname: Miao
authors.forename: Xue-Mei
authors.initials: XM
authors.lastname: Li
authors.forename: Xue-Wang
authors.initials: XW
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents