title: Trends and outcomes of infective endocarditis in patients on dialysis.
abstract: Dialysis patients are at high risk for infective endocarditis (IE); however, no large contemporary data exist on this issue. We examined outcomes of 44 816 patients with IE on dialysis and 202 547 patients with IE not on dialysis from the Nationwide Inpatient Sample database from 2006 thorough 2011. Dialysis patients were younger (59 ± 15 years vs 62 ± 18 years) and more likely to be female (47% vs 40%) and African-American (47% vs 40%; all P < 0.001). Hospitalizations for IE in the dialysis group increased from 175 to 222 per 10 000 patients (Ptrend= 0.04). Staphylococcus aureus was the most common microorganism isolated in both dialysis (61%) and nondialysis (45%) groups. IE due to S aureus (adjusted odds ratio [aOR]: 1.79, 95% confidence interval [CI]: 1.73-1.84), non-aureus staphylococcus (aOR: 1.72, 95% CI: 1.64-1.80), and fungi (aOR: 1.4, 95% CI: 1.12-1.78) were more likely in the dialysis group, whereas infection due to gram-negative bacteria (aOR: 0.85, 95% CI: 0.81-0.89), streptococci (aOR: 0.38, 95% CI: 0.36-0.39), and enterococci (aOR: 0.78, 95% CI: 0.74-0.82) were less likely (all P < 0.001). Dialysis patients had higher in-hospital mortality (aOR: 2.13, 95% CI: 2.04-2.21), lower likelihood of valve-replacement surgery (aOR: 0.82, 95% CI: 0.76-0.86), and higher incidence of stroke (aOR: 1.08, 95% CI: 1.03-1.12; all P < 0.001). We demonstrate rising incidence of IE-related hospitalizations in dialysis patients, highlight significant differences in baseline comorbidities and microbiology of IE compared with the general population, and validate the association of long-term dialysis with worse in-hospital outcomes.
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Nirmanmoh
authors.initials: N
authors.lastname: Bhatia
authors.affiliation: Division of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Sahil
authors.identifier: http://orcid.org/0000-0002-2075-7807
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Internal Medicine, St. Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Aakash
authors.initials: A
authors.lastname: Garg
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Divyanshu
authors.initials: D
authors.lastname: Mohananey
authors.affiliation: Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Manyoo
authors.identifier: http://orcid.org/0000-0002-0549-9440
authors.initials: M
authors.lastname: Agarwal
authors.affiliation: Division of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Lohit
authors.initials: L
authors.lastname: Garg
authors.affiliation: Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Agrawal
authors.affiliation: Division of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Amitoj
authors.initials: A
authors.lastname: Singh
authors.affiliation: Division of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Sudip
authors.initials: S
authors.lastname: Nanda
authors.affiliation: Division of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Jamshid
authors.initials: J
authors.lastname: Shirani
mesh_terms: D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: End-Stage Renal Disease; Infective Endocarditis; Outcomes