Endocarditis In Hemodialysis Patients Research Articles

Factors Related to the Development of Infective Endocarditis in Hemodialysis Patients in a Third-Level Hospital in Panama.

Venous access for hemodialysis (HD) makes patients more susceptible to transient bacteremia, predisposing them to the development of infective endocarditis (IE). Among the risk factors observed in this population are temporary access to HD, hypoalbuminemia, diabetes mellitus, female gender, anemia, and colonization by methicillin-resistant Staphylococcus aureus (MRSA). A retrospective case-control study with a one-to-two ratio was carried out on patients with chronic kidney disease (CKD) undergoing renal replacement therapy with at least one vascular access for HD at Complejo Hospitalario Dr. Arnulfo Arias Madrid (CHDrAAM) from 2010 to 2020. Sociodemographic variables, past medical history, and data on current HD were studied. The odds ratio (OR) and adjusted odds ratio (aOR) were calculated for the collected variables. No statistically significant differences between the groups were observed in sociodemographic variables. In terms of past medical history, the cases showed a predominance of coronary disease (47.6% vs 4.8%; OR: 37.27), valvular disease (23.8% vs 0%), and heart failure (33.3% vs 4.8%; OR: 10). In the cases, the use of a temporary catheter was more prevalent (61.9% vs 33.3%; OR: 3.25), and subclavian access was more frequently recorded (28.6% vs 2.4%; OR: 14.4). A short duration of venous access (<30 days) was found in a greater proportion of cases (23.8% vs 4.8%; OR: 6.25). The main pathogen isolated was S. aureus (33.3%), and the most affected valve was the aortic valve (59.1%). Fever was found in 100% of the reported cases, and up to 47.6% presented with a recent murmur. Similar to previous studies conducted in other countries, we identified a history of pre-existing valve disease, the use of a temporary catheter, and recent venous access as risk factors. Contrary to what has been reported in the literature, this study did not find female sex, diabetes mellitus, and hypoalbuminemia as risks. Factors such as a history of coronary artery disease, heart failure, preexisting valvular disease, the use of a temporary catheter, subclavian venous access, and short duration of venous access (<30 days) were identified as risk factors for the development of IE in patients with CKD on HD.

The risk of endocarditis in hemodialysis patients who have undergone invasive dental treatment: a cohort case-control analysis of the Taiwan National Health Insurance Database.

The objective of this study was to determine if hemodialysis patients who have undergone an invasive dental treatment are at risk of developing infective endocarditis. This study was a cohort case-control design and used secondary data collected from the National Health Insurance Research Database of Taiwan. The case group and the control group were each comprised of 19,602 hemodialysis patients. The control group was matched for four variables: age, gender, a medical history of diabetes mellitus, and a cerebrovascular event. After matching, the case group and the control group were each comprised of 19,602 hemodialysis patients. Cox regression analysis determined hazard ratios and 95% confidence intervals. Patients were followed up at 1month and 3months after receiving invasive dental treatment. The results showed the cohort case-control hazard ratio was 0.88 (95% CI, 0.49, 1.57) 1month after receiving invasive dental treatment. Three months after receiving IDT, the cohort case-control hazard ratio was 1.04 (95% CI, 0.71, 1.52). Hazard ratios did not differ significantly between groups. Hemodialysis patients who received invasive dental treatment had no greater risk of developing infective endocarditis than matched control patients. The results of this study should alleviate concerns for hemodialysis patients and dentists about invasive dental treatment procedures. We recommend hemodialysis patients undergo invasive dental treatment when needed. The results of this study showed that invasive dental treatment did not increase their risk of developing infective endocarditis. Hemodialysis patients in need of an invasive dental procedure should be encouraged to undergo treatment if the dentist deems it necessary.

A Giant Lung Abscess Complicating Tricuspid Valve Infective Endocarditis: A Rare Case of a Dreadful Complication

Infective endocarditis in hemodialysis patients is a serious complication of the dialysis catheter. Pulmonary complications are rare and may include lung abscess. We report the case of a 72-year-old chronic hemodialysis female patient diagnosed with tricuspid valve complicated by a giant lung abscesses. This case underlines the impact on poor outcomes of IE in hemodialysis patients.

MO733RISK FACTORS FOR INFECTIVE ENDOCARDITIS IN PATIENTS RECEIVING HAEMODIALYSIS- A PROPENSITY MATCHED COHORT STUDY

Abstract Background and Aims Infective endocarditis (IE) is a serious infective complication that usually results in prolonged hospitalisation and is associated with high morbidity and mortality. It is sometimes difficult to promptly diagnose infective endocarditis when a patient receiving hemodialysis presents with signs and symptoms of bacteremia, a delay which can lead to worse outcomes. In this study, we aimed to identify the risk factors that can predict infective endocarditis in haemodialysis patients with bacteremia. Method This retrospective observational study was conducted on all patients diagnosed with infective endocarditis (IE) and receiving maintenance hemodialysis between 2005 and 2018 in Salford Royal Hospital and its satellite dialysis units (catchment population of 1.5 million). The IE patients were propensity score matched in a 1:2 ratio with similar hemodialysis patients without IE but with bacteremia between 2011 and 2015. Propensity scores were generated by using binary logistic regression analysis incorporating age, gender, diabetes status, and dialysis vintage as variables. Logistic regression analysis was used to predict the risk factors associated with developing IE. Statistics were performed using SPSS version-24. Results We had a sample of 105 patients (35 IE vs 70 bacteremia). The median age of the patients was 65 years with a predominance of males (60%). 43% were diabetic, 11.5% were receiving immunosuppression and 72% had a catheter for dialysis access. IE patients had higher peak C-reactive protein (CRP) during admission compared to patients with bacteremia and no IE (253 mg/l vs 152 mg/l, p=0.001). Patients who developed IE had a longer duration of dialysis catheter use than the bacteremia group (150 vs 19 days; p&amp;lt;0.001) (table 1). There was no significant difference between causative microorganisms in both groups. Staphylococcus aureus caused most cases (54% in IE and 47% in bacteremia). Our study showed clearly that patients who had IE had longer hospital stay (45 vs 18 days, p=0.001) with a far higher 30-day mortality rate (54.3% vs 17.1%, p&amp;lt;0.001). Logistic regression analysis showed previous valvular heart diseases (OR: 20.1; p&amp;lt;0.001), a higher peak CRP (OR:1.01; p=0.001), and a longer duration of catheter use (OR: 1.01; p=0.035) as significant predictors for infective endocarditis (table 2). Conclusion Bacteremia in patients receiving hemodialysis through a catheter as access should be actively investigated with a high index of suspicion for IE particularly those having valvular heart diseases, hypertension, higher peak CRP, and those with a longer duration of dialysis catheter usage. Work up may need to include invasive investigations such as transesophageal echocardiogram to confirm or reliably rule out this devastating condition.

Infective endocarditis in hemodialysis patients: A 10-year observational single center study.

The incidence of infective endocarditis (IE) in chronic hemodialysis (CHD) patients remains high, despite the preventive measures implemented by nephrologists, especially the rigorous respect of hygiene, the use of antibiotic locks for catheters and the use of tunneled catheters instead of non-tunneled. The objective of this study was to determine the clinical, biological, and echocardiographic characteristics, and the prognosis of IE in CHD. It was a retrospective study, conducted from December 2010 to March 2020, at the Nephrology and Cardiology units of University Hospital in Oujda, Morocco. We compiled a series of 31 CHD patients having developed IE. Eleven cases (35.4%) were collected between 2010 and 2015, and 20 cases (64.6%) between 2016 and 2020. The mean age was 47 ± 19 years, 58% were male, and 25.8% of patients had diabetes. Vascular access for hemodialysis was by arteriovenous fistula, non-tunneled catheter, and tunneled catheter in 22.5%, 32.2%, and 45.2%, of the cases, respectively. About 25.8% of patients had benefited from more than two catheters (tunneled or non-tunneled) during the 3 months preceding the occurrence of IE. The mitral, tricuspid, and aortic valves were the site of IE in 41.9%, 41.9%, and 13% of the cases, respectively. Right heart IE and left heart IE were observed in 42% (13 cases) and 58% (18 cases) of cases, respectively. Blood cultures were negative in 58.1% of the cases at the time of diagnosis of IE. Staphylococcus aureus was identified in 69.2% of the cases. Mortality occurred in 54.8% of the cases. IE remains a severe condition in CHD patients with an increasing incidence. Rigorous prevention and screening strategies should be implemented at the hemodialysis centers.

INFECTIVE ENDOCARDITIS-RELATED BILATERAL SPONTANEOUS PNEUMOTHORAX IN A HAEMODIALYSIS PATIENT

(MRSA) bacteraemia in another hospi-tal. Two months prior to this admission, he received implanta-tion of a cuffed tunnelled double-lumen catheter in the right jugular vein as the transient vascular access for haemodialy-sis. On the third day of this hospitalization, the haemodialysis catheter was removed under the impression of its related infection. Progressive shortness of breath developed and a chest radiograph showed a left-sided pneumothorax (Fig-ure1A, arrowheads) with progressive consolidation over the right upper lobe, which was absent 3 days before. A com-puted tomographic scan performed after chest tube insertion (Figure 1B) revealed incomplete expansion of the left lung as well as progression of multiple nodular infiltrations and sub-pleural cavities in bilateral lung fields (black arrows). These pulmonary cavities were caused by septic emboli originating from multiple vegetations over the tricuspid valve demon-strated by the transoesophageal echocardiography (Fig-ure 1C, white arrows). Spontaneous pneumothorax has long been recognized as a rare complication of tricuspid endocarditis (1), especially in intravenous drug abusers (2). Bacteraemia associated with tunnelled, cuffed haemodialysis catheters is relatively com-mon (3), and the prognosis of infective endocarditis in hae-modialysis patients is poor (4). The occurrence of persistent bacteraemia in haemodialysis patients using central venous catheter shall prompt the physician to search for possible catheter-related infections, and spontaneous pneumothorax may occur as a catastrophic complication.

Bacterial endocarditis in haemodialysis patients. Is frequent heparinisation protecting embolisation?

Bacterial endocarditis in haemodialysis patients. Is frequent heparinisation protecting embolisation?

Diagnosis of endocarditis caused byMycobacteriumabscessus

We report a fatal case of native valve endocarditis due to Mycobacterium abscessus in a hemodialysis patient. The diagnosis was based on culture isolation of acid-fast bacilli from peripheral blood and a permanent catheter tip, and their identification as M abscessus by a reverse hybridization-based assay and direct DNA sequencing of the 16S-23S internal transcribed spacer region. Rapid diagnosis and combination therapy are essential to minimize mortality due to this pathogen. Although combination therapy was started with clarithromycin and tigecycline, the patient refused to take clarithromycin due to severe abdominal pain. The patient became afebrile after therapy with tigecycline alone although bacteremia persisted. He was discharged against medical advice and readmitted three months later for persistent fever. His blood cultures again yielded M abscessus and a transesophageal echocardiogram showed two mobile vegetations. The patient was noncompliant with therapy and died due to cardiac arrest and multiorgan failure. This report shows that M abscessus should also be considered in the differential diagnosis of infective endocarditis in hemodialysis patients.

Infective endocarditis in hemodialysis patients: clinical features, echocardiographic data and outcome

Infective endocarditis (IE) is a dreaded complication in hemodialysis (HD) patients and is strongly associated with morbidity and mortality. Our aim was to investigate clinical and echocardiographic characteristics, microbiological profile, management and outcome of patients on HD in a Tunisian (Tunisia, North Africa) high-volume tertiary-care centre. Among 182 patients who fulfilled the modified Duke criteria for infective endocarditis between January 1997 and December 2006, 16 were on chronic HD and were included in the study. Mean age was 52.5 +/- 22.3 years, ten were male and arteriovenous fistulas were the most commonly used access sites (12 out of 16 cases). Average duration of dialysis was 27.3 +/- 30 months. Major causative organisms were Staphylococcus species (including methicillin-resistant Staphylococcus aureus) in 11 (68.7%) of the 16 cases. The mitral valve was the most commonly affected [9 patients out of 16 (56.2%)], followed by aortic valve in 4 cases (25.0%) and tricuspid valve in 1 case (6.2%). Complications were frequent, including congestive heart failure (56.2%), secondary septic localisations (31.2%), arterial emboli (18.7%), and cerebral haemorrhage (6.2%). Five patients underwent surgery and seven died during hospitalization (43.7% mortality rate). No recurrences of IE were recorded in the nine survivors after average 21.7 +/- 17.3 months follow-up. In this largest reported confirmed IE series in dialysis patients in a developing country, mortality was very high; mitral valve was the most commonly affected valve. Staphylococcus species were the major causative organisms.

Mitral paravalvular abscess with left ventriculo-atrial fistula in a patient on dialysis

BackgroundInfective endocarditis in hemodialysis patients is challenging but is becoming more common recently.Case reportA 64-year-old man with end-stage renal disease on hemodialysis presented with infective endocarditis of mitral valve and coronary artery disease after commencing training for home hemodialysis. During a course of antibiotic treatment the patient developed left ventriculo-atrial fistula due to mitral paravalvular abscess. Abscess debridement followed by reconstruction of the mitral annulus with fresh autologous pericardial patch and mitral valve replacement using a mechanical prosthesis with concomitant coronary artery bypass grafting was performed successfully.ConclusionTimely diagnosis, proper antibiotic treatment and early surgical intervention including aggressive debridement should improve the outcome of this high-risk disease.

Infective endocarditis in haemodialysis patients: 16-year experience at one institution.

Objectives. To ascertain the characteristics, outcomes and correlates of mortality in chronic haemodialysis patients with confirmed infective endocarditis (IE).Methods. Patients were identified by computerized discharge diagnosis and chart review of admissions to Saint Louis University hospital from January 1990 through January 2006. Modified Duke Criteria were retrospectively applied to confirm the diagnosis of IE. Survivors and non-survivors were compared to identify clinical correlates of IE mortality.Results. We identified 59 patients with IE who had received dialysis for a mean duration of 52.9 ± 58.0 months prior to IE diagnosis. Dialysis access comprised 28 (47.5%) catheters, 26 (44.1%) arteriovenous grafts, 3 (5.1%) arteriovenous fistulas and 2 (3.4%) life sites. The causative organisms were MRSA in 15 (25%), MSSA 12 (20%), S. Epidermidis 10 (17%), Enterococci 8 (14%), multi-organism 6 (10%), gram negative 2 (3%) and VRE 1 (2%). Valves involved were mitral valve in 37 (63%), aortic valve in 10 (17%), tricuspid valve in 3 (5%) and multiple valves in 8 (13%) cases. Patient mortality was 28.8% (n = 17) during hospitalization, 37.9% (n = 22) at 30 days and 63.1% (n = 36) at 1 year. In multivariable logistic regression, the adjusted odds ratio of in-hospital mortality was 3.6-fold higher in those with IE and arteriovenous grafts (P = 0.04, 95% CI 1.04–12.27) compared to other forms of dialysis access.Conclusion. Mortality of IE remains high, despite the availability of potent antibiotics. Patients with arteriovenous grafts who develop IE may face increased risk for in-hospital mortality, perhaps reflecting difficulty eradicating endovascular infection if a graft is involved.

Epidemiology and Clinical Outcomes of Infective Endocarditis in Hemodialysis Patients

Infective endocarditis is one of the most serious complications of bacteremia in patients undergoing chronic hemodialysis and is more frequent than previously recognized. The aim of our study was to describe the clinical characteristics, outcome, and factors predicting mortality of infective endocarditis in hemodialysis patients. In this retrospective review, all patients on chronic hemodialysis admitted to a 600-bed urban teaching hospital with infective endocarditis over a 15-year period (1990 to 2004), were identified using discharge codes. Modified Duke criteria were retrospectively applied, and patients fulfilling the criteria for definite endocarditis were included in the study. Sixty-nine patients on hemodialysis with definite endocarditis were identified. The predominant type of vascular access was double-lumen catheter (66.7%). The mean duration of dialysis was 37 +/- 32 months. The predominant organism was Staphylococcus aureus (57.9%), of which 57.5% were methicillin susceptible. The most frequently infected valve was mitral (49.3%), followed by aortic (21.7%) and tricuspid (10.1%) valves. The cardiac and neurologic complication rates were 40.6% and 37.7%, respectively. Fifteen patients underwent valvular heart surgery. The overall in-hospital mortality was 49.3% (34 of 69). More patients who had surgery survived than patients who did not (12 of 15 versus 23 of 54; p = 0.018, odds ratio = 5.39, 95% confidence interval: 1.3 to 17.6). On logistic regression, valve surgery was the only independent factor predicting survival (p = 0.023). The prognosis of infective endocarditis in hemodialysis patients is poor, with surgery serving as an independent predictor of survival.

Invited commentary

Invited commentary

Infective endocarditis in dialysis patients: New challenges and old

Since the 1960s chronic hemodialysis (HD) has been recognized as a risk factor for the development of infective endocarditis (IE). Historically, it has been particularly associated with vascular access via dual lumen catheters. We wished to examine the risk factors for, and consequences of, IE in the modern dialysis era. Cases of IE (using the Duke criteria) at St. Thomas' Hospital (1980 to 1995), Guy's (1995 to 2002), and King's College Hospitals (1996 to 2002) were reviewed. Twenty-eight patients were identified as having developed IE (30 episodes of IE). Twenty-seven patients were on long-term HD and one patient was on peritoneal dialysis (PD). Mean age was 54.1 years, and mean duration of HD prior to IE was 46.3 months. Eight patients were diabetic. Primary HD hemoaccess was an arteriovenous fistula (AVF) in 41.3%, a dual-lumen tunneled catheter (DLTC) in 37.9%, a polytetrafluoroethylene (PTFE) graft in 10.3%, and a dual- lumen non-tunneled catheter (DLNTC) in 4%. The presumed source of sepsis was directly related to hemoaccess in 25 HD patients: DLTC in 48%; AVF in 32%; PTFE in 12%; and DLNTC in 4%. Staphylococcus aureus[including methicillin resistant Staphylococcus aureus (MRSA)] was present in 63.3%. The mitral valve was affected in 41.4% of patients, aortic valve in 37.9% of patients, and both valves were affected in 17.2% of patients. Of note, 51.7% of patients had an abnormal valve before the episode of IE. In 15 cases surgery was undertaken. Fourteen patients survived to discharge, and 12 survived for 30 days. In 15 cases antibiotic treatment alone was employed; in this case, eight patients died and seven survived to discharge. This is the largest reported confirmed IE series in dialysis patients. Infective endocarditis in HD patients remains a challenging problem-although hemoaccess via dual-lumen catheters remains a significant risk, many cases developed in patients with AVFs and this group suffered the greatest mortality. An abnormal valve (frequently calcified) was another risk factor; because valve calcification is now common after 5 years on dialysis, more effort in preventing this avoidable form of ectopic calcification may reduce the risk of developing IE.

Epidemiology and Outcome of Infective Endocarditis in Hemodialysis Patients

Survival in patients with infective endocarditis (IE) ranges from 4 to 50% depending on the type of organism, the type of valve involvement and the type of treatment. We conducted a retrospective analysis of data in hemodialysis (HD) patients at our center from 1990 to 2000. Demographics, risk factors, and outcome data were extracted in the subgroup of patients with first-episode IE diagnosed primarily by echocardiography. A total of 2239 patients underwent HD at our center. Thirty-two (1.4%) had IE defined using the Duke Criteria. Permanent and temporary venous dialysis catheters, arteriovenous (AV) grafts, and AV fistulae were used in 19 (59%), 12 (38%), and 1 (3%) patient respectively. Mean access duration was 7.6 +/- 7.9 months. Thirty (94%) patients had positive blood cultures, with the majority having Staphylococcus aureus bacteremia. Two (7%) patients had positive echocardiographic findings but negative blood cultures due to the commencement of empiric antibiotic therapy prior to blood cultures. The mitral valve was mainly affected. Transesophageal echocardiography was performed in 23 (72%) patients and detected an intracardiac mass in all 23 patients. One-year mortality was 56.3%. A poor 1-year prognosis was associated with presenting features of low hemoglobin, elevated leukocyte count, hypoalbuminemia, severe aortic and mitral regurgitation, and annular calcification in mitral valve IE. The prevalence of IE in HD patients is 1.4%. One-year mortality was 56.3%. Close observation is required during the first year when patients with severe valvular regurgitation and hematological abnormalities have a high mortality.

Infective Endocarditis in Patients Receiving Long-term Hemodialysis

To ascertain the predominant characteristics of patients receiving long-term dialysis who develop infective endocarditis (IE). We reviewed the records of all chronic hemodialysis patients who had IE at Mayo Clinic, Rochester, Minn, between 1983 and 1997. Twenty episodes of IE occurred in 17 patients. One patient had 3 episodes of IE, and 1 patient had 2 episodes of IE; each episode was caused by a different organism. The mean +/- SD age of our patients was 63 +/- 11 years; there were 13 males; 6 patients had diabetes mellitus; and the mean +/- SD duration of hemodialysis prior to IE was 24.2 +/- 20.5 months. This analysis included 10 episodes of IE (occurring in 9 patients) within the Mayo Clinic Dialysis System during which time 223,358 hemodialysis treatments were delivered, giving a rate of 10 IE episode per 223,336 hemodialysis treatments. Among all 20 IE episodes, there were 14 synthetic arteriovenous grafts, 4 permanent venous dialysis catheters, 2 temporary venous dialysis catheters, and 2 native arteriovenous fistulas (2 accesses in 2 patients), and access had been in place for a mean +/- SD of 15.9 +/- 18.6 months. The portal of infection was the hemodialysis access in 13 episodes of IE. The causative organisms for IE were Staphylococcus aureus in 8 cases, Enterococcus sp in 4 cases, viridans streptococcus in 3 cases, Staphylococcus epidermidis in 2 cases, and 1 case each of Streptococcus bovis, group G beta-hemolytic streptococcus, and Aspergillus sp. The mitral valve was involved in 9 cases, the aortic valve was involved in 5 cases, and the tricuspid and pulmonic valves were involved in 1 case each. Patient survival (after the first episode of IE) was 71% at 30 days; 53% at 60 days; and 35% at 1 year. Echocardiography was performed in 19 episodes of IE. The transthoracic echocardiogram was 62.5% sensitive and 40% specific for the presence of definite or probable vegetations. Univariate analysis for factors affecting 60-day survival show that presence of right-sided IE, vegetation size greater than 2.0 cm3, diagnosis of diabetes mellitus, and initial leukocyte count greater than 12.5 x 10(9)/L were poor prognostic factors. Aortic valve involvement carried a better prognosis. Infective endocarditis in hemodialysis patients is relatively infrequent but has a high mortality. Patients with synthetic intravascular dialysis angioaccess (synthetic grafts and venous catheters) are more likely to develop IE than patients with native arteriovenous fistulas. Transesophageal echocardiography is a preferred echocardiographic study for suspected cases of IE. Prolonged antibiotic therapy is needed for all patients, and close monitoring is needed for patients with right-sided IE, large vegetations, diabetes mellitus, and an elevated leukocyte count.

Bacterial endocarditis in hemodialysis patients

Infective endocarditis (IE) is one of the most serious complications of bacteremia. Hemodialysis patients with prosthetic vascular access devices such as dual-lumen cuffed venous catheters and polytetrafluoroethylene (PTFE) grafts are at increased risk for bacteremia compared with patients with primary arteriovenous fistulae (PAVF). We present 20 cases of IE in hemodialysis patients seen at our institution over a 7-year period. Eight patients had PTFE grafts, 11 had dual-lumen cuffed catheters, and one had a PAVF. All patients underwent transthoracic echocardiography (TTE) and 16 patients also received transesophageal echocardiography (TEE). The Duke Criteria were used to characterize patients as definite or possible IE. Organisms were Staphylococcus aureus (55%), Staphylococcus epidermidis (25%), and Enterococcus sp (10%). The mitral valve (50%) was the most commonly affected valve, followed by aortic (30%) and right-sided IE (25%). Valve replacement was performed in five patients, of whom three survived hospitalization. The overall mortality rate for the series was 30%. All the dual-lumen cuffed catheters were removed, while only two of the eight PTFE grafts were removed. Four of the six patients who died had PTFE grafts, of which one was judged to be infected and removed. Echocardiography was essential to the diagnosis of IE. Vegetations were found in 50% by TTE and 81% by TEE. Six patients with no vegetations on TTE were found to have vegetations on TEE.

Staphylococcal infections in the hemodialysis unit: prevention using infection control principles.

Infections are a leading cause of death in patients on chronic hemodialysis, second only to cardiovascular disease.'-Staphylococcus aureus is the major pathogen and the leading cause of access-site infection, bacteremia, and endocarditis in hemodialysis patients and is responsible for more deaths than any other organism.3-5 In this issue of Infection Control and Hospital Epidemiology (pp 534-541), Kaplowitz et al report that S aureus caused four of five bacteremias and seven of nine access-site infections over