title: Severe tricuspid valve endocarditis related to tunneled catheters in chronic hemodialysis patients: when should the catheter be removed?
abstract: BACKGROUND
  Hemodialysis (HD) patients are predisposed to infective endocarditis (IE) mainly due to repeated manipulation of the vascular access. However, catheter seeding and IE may also result from a distant infection site.
  
  
  METHODS
  A diabetic patient who was maintained on regular HD through a permanent catheter in the right internal jugular vein presented with septicemia of urinary origin due to Pseudomonas aeruginosa. He was treated with injectable antibiotics for 15 days. Few days after the end of the treatment period he presented with inflammation of the catheter exit site. Blood cultures revealed Pseudomonas aeruginosa and echocardiography showed a large vegetation on the tricuspid valve, confirming the diagnosis of IE. The patient improved after catheter removal and treatment with ceftazidime, vancomycin and amikacin. Another patient who was maintained on chronic HD through a tunneled catheter in the right internal jugular vein presented with a limited infection in the sub-cutaneous tunnel of the catheter that improved after treatment with injectable antibiotics. Two months later, he presented with severe sepsis without signs of local infection of the catheter. Chest radiography showed right sided infiltrates. Injectable antibiotic therapy was given without improvement. Blood cultures were negative but echocardiography showed a large tricuspid valve vegetation. Antibiotic regimen was modified to include vancomycin, amikacin and ceftazidime and the catheter was removed. Unfortunately, the patient died two days after diagnosing IE.
  
  
  CONCLUSIONS
  catheter seeding and IE may be a consequence of sepsis originating away from the HD catheter site. Tunneled catheters may need to be preemptively removed in such situations to prevent serious IE.
authors: MedicalSchool, University Mohamed First, Oujda, Morocco. bentatayassamine@yahoo.fr
authors: Yassamine
authors: Y
authors: Bentata
authors: Intissar
authors: I
authors: Haddiya
authors: Nabila
authors: N
authors: Ismailli
authors: Adnane
authors: A
authors: Benzirare
authors: Omar
authors: O
authors: Elmahi
authors: Abderrahim
authors: A
authors: Azzouzi
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D020878:Device Removal / Q000379:methods*; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007601:Jugular Veins; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D014261:Tricuspid Valve
chemical_list: D000900:Anti-Bacterial Agents