Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. We aimed to highlight the clinical and microbiological specificities of IE in CHD patients, detail the therapeutic management in these patients and identify the risk factors for in-hospital mortality. We included 28 CHD patients in whom the diagnosis of IE was established according to modified Duke criteria. The mean age was 47 ± 17 years. Among them, 57% were hypertensive and 39% were diabetic. The average duration of hemodialysis was 3.5 ± 7 years. The vascular access was a tunnelled jugular catheter, arteriovenous fistula, and temporary catheter in 54%, 28%, and 18% of patients, respectively. Half of the patients presented with heart failure at admission. Methicillin-sensitive Staphylococcus is the most commonly implicated pathogen. Transthoracic echocardiography revealed vegetation in all patients. In 60% of cases, the lesion is located on the mitral valve, and in 35% it is on the tricuspid valve. Patients initially received empirical antibiotic therapy, which was adjusted according to bacteriological results. Valve surgery was indicated in 12 patients, with aortic valve replacement being the most performed procedure followed by tricuspid annuloplasty. The in-hospital mortality rate was 32%. Factors associated with mortality were severe mitral insufficiency (p = 0.036), heart failure (p = 0.043), and the presence of Methicillin-resistant Staphylococcus in blood cultures (p = 0.047). IE is a complication with high morbidity and mortality. Its increasing incidence, specificities in chronic CHD patients, and the complexity of its management require a rigorous preventive strategy. A multidisciplinary collaboration between nephrologists, infectious disease specialists, cardiologists, and surgeons is crucial to optimize therapeutic management.
References
[1]
Nucifora, G., Badano, L.P., Viale, P., Gianfagna, P., Allocca, G., Montanaro, D., et al. (2007) Infective Endocarditis in Chronic Haemodialysis Patients: An Increasing Clinical Challenge. European Heart Journal, 28, 2307-2312. https://doi.org/10.1093/eurheartj/ehm278
[2]
Schubert, C. and Moosa, M.R. (2007) Infective Endocarditis in a Hemodialysis Patient: A Dreaded Complication. Hemodialysis International, 11, 379-384. https://doi.org/10.1111/j.1542-4758.2007.00204.x
[3]
Pandey, R. and Sam, R. (2007) Infective Endocarditis in Hemodialysis Patients. The International Journal of Artificial Organs, 30, 334-337. https://doi.org/10.1177/039139880703000409
[4]
Robinson, D.L., Fowler, V.G., Sexton, D.J., Corey, R.G. and Conlon, P.J. (1997) Bacterial Endocarditis in Hemodialysis Patients. American Journal of Kidney Diseases, 30, 521-524. https://doi.org/10.1016/s0272-6386(97)90311-5
[5]
Bhatia, N., Agrawal, S., Garg, A., Mohananey, D., Sharma, A., Agarwal, M., et al. (2017) Trends and Outcomes of Infective Endocarditis in Patients on Dialysis. Clinical Cardiology, 40, 423-429. https://doi.org/10.1002/clc.22688
[6]
Pericàs, J.M., Llopis, J., Jiménez-Exposito, M.J., Kourany, W.M., Almirante, B., Carosi, G., et al. (2021) Infective Endocarditis in Patients on Chronic Hemodialysis. Journal of the American College of Cardiology, 77, 1629-1640.
[7]
Vieille, T., Winiszewski, H., Chirouze, C., Bertrand, X. and Fournier, D. (2019) Escherichia Coli Endocarditis in an Hemodialysis Patient. Médecineet Maladies Infectieuses, 49, 478-479. https://doi.org/10.1016/j.medmal.2019.03.004
[8]
Powe, N.R., Jaar, B., Furth, S.L., Hermann, J. and Briggs, W. (1999) Septicemia in Dialysis Patients: Incidence, Risk Factors, and Prognosis. Kidney International, 55, 1081-1090. https://doi.org/10.1046/j.1523-1755.1999.0550031081.x
[9]
Maraj, S., Jacobs, L.E., Kotler, M.N., Kung, S., Raja, R., Krishnasamy, P., et al. (2002) Epidemiology and Outcome of Infective Endocarditis in Hemodialysis Patients. The American Journal of the Medical Sciences, 324, 254-260. https://doi.org/10.1097/00000441-200211000-00004
[10]
Chaudry, M.S., Gislason, G.H., Kamper, A., Rix, M., Dahl, A., Østergaard, L., et al. (2018) The Impact of Hemodialysis on Mortality Risk and Cause of Death in Staphylococcus Aureus Endocarditis. BMC Nephrology, 19, Article No. 216. https://doi.org/10.1186/s12882-018-1016-0
[11]
Durante-Mangoni, E., Pafundi, P.C., Ravasio, V., Barbaro, F., Bassetti, M., Chinello, P., et al. (2016) Current Features of Infective Endocarditis in Persons on Hemodialysis: A Prevalence Study with Case Control Design from the Prospective Multicenter SEI Cohort. Infection, 44, 467-474. https://doi.org/10.1007/s15010-015-0870-y
[12]
MSD Manual Professional Edition (2022) Infective Endocarditis. https://www.msdmanuals.com/professional/cardiovascular-disorders/endocarditis/infective-endocarditis
[13]
Hauser, A.B., Stinghen, A.E.M., Kato, S., Bucharles, S., Aita, C., Yuzawa, Y., et al. (2008) Characteris Tics and Causes of Immune Dysfunction Related to Uremia and Dialysis. Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 28, 183-187. https://doi.org/10.1177/089686080802803s34
[14]
Chou, M., Wang, J., Wu, W., Weng, S., Ho, C., Lin, Z., et al. (2015) Epidemiologic Features and Long-Term Outcome of Dialysis Patients with Infective Endocarditis in Taiwan. International Journal of Cardiology, 179, 465-469. https://doi.org/10.1016/j.ijcard.2014.11.083
[15]
Delgado, V., Ajmone Marsan, N., De Waha, S., Bonaros, N., Brida, M., Burri, H., et al. (2023) 2023 ESC Guidelines for the Management of Endocarditis. European Heart Journal, 44, 3948 4042.
[16]
KDIGO (2017) Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney International Supplements, 7, 1-59.
[17]
Bentata, Y. (2017) Physiopathological Approach to Infective Endocarditis in Chronic Hemodialysis Patients: Left Heart versus Right Heart Involvement. Renal Failure, 39, 432-439. https://doi.org/10.1080/0886022x.2017.1305410
[18]
Bentata, Y., Haloui, I., Haddiya, I., Benzirar, A., El Mahi, O., Ismailli, N., et al. (2020) Infective Endocarditis in Hemodialysis Patients: A 10-Year Observational Single Center Study. The Journal of Vascular Access, 23, 149-153. https://doi.org/10.1177/1129729820970783
[19]
Nori, U.S., Manoharan, A., Thornby, J.I., Yee, J., Parasuraman, R. and Ramanathan, V. (2006) Mortality Risk Factors in Chronic Haemodialysis Patients with Infective Endocarditis. Nephrology Dialysis Transplantation, 21, 2184-2190. https://doi.org/10.1093/ndt/gfl200
[20]
Rekik, S., Trabelsi, I., Hentati, M., Hammami, A., Jemaa, M.B., Hachicha, J., et al. (2009) Infective Endocarditis in Hemodialysis Patients: Clinical Features, Echocardiographic Data and Outcome. Clinical and Experimental Nephrology, 13, 350-354. https://doi.org/10.1007/s10157-009-0172-8
[21]
Spies, C., Madison, J.R. and Schatz, I.J. (2004) Infective Endocarditis in Patients with End-Stage Renal Disease. Archives of Internal Medicine, 164, 71-75. https://doi.org/10.1001/archinte.164.1.71
[22]
Slipczuk, L., Codolosa, J.N., Davila, C.D., Romero-Corral, A., Yun, J., Pressman, G.S., et al. (2013) Infective Endocarditis Epidemiology over Five Decades: A Systematic Review. PLOS ONE, 8, e82665. https://doi.org/10.1371/journal.pone.0082665
[23]
Wertheim, H.F., Melles, D.C., Vos, M.C., Van Leeuwen, W., Van Belkum, A., Verbrugh, H.A., et al. (2005) The Role of Nasal Carriage in Staphylococcus Aureus Infections. The Lancet Infectious Diseases, 5, 751-762. https://doi.org/10.1016/s1473-3099(05)70295-4
[24]
Engemann, J.J., Friedman, J.Y., Reed, S.D., Griffiths, R.I., Szczech, L.A., Kaye, K.S., et al. (2005) Clinical Outcomes and Costs Due to StaphylococcusaureusBacteremia among Patients Receiving Long-Term Hemodialysis. Infection Control & Hospital Epidemiology, 26, 534-539. https://doi.org/10.1086/502580
[25]
Troidle, L., Eisen, T., Pacelli, L. and Finkelstein, F. (2007) Complications Associated with the Development of Bacteremia with Staphylococcusaureus. Hemodialysis International, 11, 72-75. https://doi.org/10.1111/j.1542-4758.2007.00156.x
[26]
Martín-Dávila, P., Navas, E., Fortún, J., Moya, J.L., Cobo, J., Pintado, V., et al. (2005) Analysis of Mortality and Risk Factors Associated with Native Valve Endocarditis in Drug Users: The Importance of Vegetation Size. American Heart Journal, 150, 1099-1106. https://doi.org/10.1016/j.ahj.2005.02.009
[27]
Chu, V.H., Park, L.P., Athan, E., Delahaye, F., Freiberger, T., Lamas, C., et al. (2015) Association between Surgical Indications, Operative Risk, and Clinical Outcome in Infective Endocarditis. Circulation, 131, 131-140. https://doi.org/10.1161/circulationaha.114.012461
[28]
Woller III, J.A., Walsh, V.L., Robichaux, C., Thourani, V.H. and Jacob, J.T. (2018) Predictors of Surgical Intervention in Dialysis Patients with Infective Endocarditis. Open Forum Infectious Diseases, 5, ofy265. https://doi.org/10.1093/ofid/ofy265
[29]
Sadeghi, M., Behdad, S. and Shahsanaei, F. (2021) Infective Endocarditis and Its Short and Long-Term Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis. Current Problems in Cardiology, 46, Article ID: 100680. https://doi.org/10.1016/j.cpcardiol.2020.100680
