title: Infective endocarditis in chronic hemodialysis patients: experience from Morocco.
abstract: Since the 1960s, regular hemodialysis (HD) was recognized as a risk factor for the development of infective endocarditis (IE), particularly at vascular access sites. The present report describes our experience at the Etat Major General Agadir, Morocco, of taking care of IE in patients on regular dialysis. A retrospective analysis was made of five cases of IE in patients receiving regular HD having arteriovenous fistula as vascular access. They were sent from four private centers and admitted in our formation between January 2004 and March 2009. Infective endocarditis was detected after 34.5 months following initiation of dialysis. The causative organisms included Staphylococcus and Enterococcus in two cases each and negative blood culture in one case. A recent history of infection (<3 months) of the vascular access was found in three cases. Peripheric embolic phenomena were noted in two cases. A pre-existing heart disease was common and contributed to heart failure. Mortality was frequent due to valvular perforations and congestive heart failure, making the medical treatment alone unsatisfactory. Two patients survived and three of our patients received a prosthetic valve replacement, with a median survival after surgery of 10.3 months/person. The clinical diagnosis of infective endocarditis in regularly dialyzed patients remains difficult, with the presence of vascular calcification as a common risk factor. The vascular catheter infections are the cardinal gateway of pathogenic organisms, which are mainly Staphylococcus. The prognosis is bad and the mortality is significant, whereas medical and surgical treatments are often established in these patients who have many factors of comorbidity.
authors.affiliation: Agadir Hemodialysis Center, First Medical Center, Agadir, Morocco.
authors.forename: Dina
authors.initials: D
authors.lastname: Montasser
authors.forename: Abdelali
authors.initials: A
authors.lastname: Bahadi
authors.forename: Yassir
authors.initials: Y
authors.lastname: Zajjari
authors.forename: Mohamed
authors.initials: M
authors.lastname: Asserraji
authors.forename: Ahmed
authors.initials: A
authors.lastname: Alayoude
authors.forename: Omar
authors.initials: O
authors.lastname: Moujoud
authors.forename: Toufik
authors.initials: T
authors.lastname: Aattif
authors.forename: Moncef
authors.initials: M
authors.lastname: Kadiri
authors.forename: Nadir
authors.initials: N
authors.lastname: Zemraoui
authors.forename: Driss
authors.initials: D
authors.lastname: El Kabbaj
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hassani
authors.forename: Mohamed
authors.initials: M
authors.lastname: Benyahia
authors.forename: Mustapha
authors.initials: M
authors.lastname: El Allam
authors.forename: Zouhir
authors.initials: Z
authors.lastname: Oualim
authors.forename: Ismail
authors.initials: I
authors.lastname: Akhmouch
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D002908:Chronic Disease; D015897:Comorbidity; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents