title: Current features of infective endocarditis in persons on hemodialysis: a prevalence study with case control design from the prospective multicenter SEI cohort.
abstract: OBJECTIVE
  Persons on hemodialysis (HD) are at high risk of infective endocarditis (IE). In non-comparative retrospective studies, a higher rate of mortality was reported in IE on HD. We assessed risk factors, clinical characteristics, and outcomes of IE in HD.
  
  
  METHODS
  This was a prevalence study with a case control methodology on a set of data from the prospectively followed cohort of the Studio Endocarditi Italiano (SEI), conducted between 2004 and 2011. Included were 42 consecutive cases of IE HD subjects and 126 controls not on HD, matched for age, sex, type of IE, and heart side involved. Clinical, echocardiographic, microbiological features, and disease complications and therapeutic modalities were assessed.
  
  
  RESULTS
  HD patients were more often diabetics (42.9 vs 18.2 % in no-HD; p = 0.007) and immune-suppressed (16.7 vs 3.2 %; p = 0.02), and had a higher rate of predisposing cardiac conditions (45 vs 25 %; p = 0.031). A higher prevalence of health care-related acquisition and a shorter diagnostic delay was observed in IE on HD, that was more likely to be caused by staphylococci and less by streptococci (p < 0.002). Cardiac surgery was performed in 38 % of HD patients and 36.5 % of no-HD patients (p = 0.856). Complications were similar and in-hospital mortality did not differ significantly (26.2 % in HD vs 15.9 % in no-HD; p = 0.168).
  
  
  CONCLUSIONS
  IE in persons on HD is characterized by distinctive clinical features, including a higher prevalence of some important comorbidities. Inconsistent with prior studies, we could not confirm a higher rate of complications and mortality in HD patients with IE.
authors.affiliation: Internal Medicine, Monaldi Hospital, University of Naples SUN, Naples, Italy. emanuele.durante@unina2.it.|Second University of Naples c/o Ospedale Monaldi, Via L. Bianchi, 80131, Naples, Italy. emanuele.durante@unina2.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Durante-Mangoni
authors.affiliation: Internal Medicine, Monaldi Hospital, University of Naples SUN, Naples, Italy.
authors.forename: Pia Clara
authors.initials: PC
authors.lastname: Pafundi
authors.affiliation: Infectious Diseases, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Ravasio
authors.affiliation: Infectious Diseases, Padua University Hospital, Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Barbaro
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: 2nd Division of Infectious Diseases, INMI 'L. Spallanzani', Rome, Italy.
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Chinello
authors.affiliation: Department of Public Health, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.affiliation: Infectious Diseases, University of Perugia, Perugia, Italy.
authors.forename: Maria Bruna
authors.initials: MB
authors.lastname: Pasticci
authors.affiliation: Infectious Diseases, S. Maria di Ca' Foncello Hospital, Treviso, Italy.
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Scotton
authors.affiliation: Infectious Diseases, University of Brescia, Brescia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Stellini
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Tripodi
authors.affiliation: Internal Medicine, Monaldi Hospital, University of Naples SUN, Naples, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Utili
authors.affiliation: Infectious Diseases, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Rizzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004697:Endocarditis, Bacterial / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Case–control study; Endocarditis; Hemodialysis; Risk factors; Staphylococcus aureus