Vascular and cardiac infections in end-stage renal disease

Patients with end-stage renal disease (ESRD) receiving hemodialysis (HD) are vulnerable to intravascular and endocardial infections. These include vascular access infections, vascular stent infections, and bacterial endocarditis. Staphylococcus aureus is the most commonly encountered microorganism in these conditions. Prolonged intravenous antibiotic therapy is often indicated in these infections. Surgical removal of the infected vascular access or stent may be required. Infective endocarditis occurs less frequently in renal transplant recipients than in patients on HD. Although bacterial endocarditis may occur, fungal endocarditis with organisms such as Aspergillus and Candida species occurs with disproportionately high frequency among renal transplant recipients because of immunosuppression. Prolonged intravenous antibiotic or antifungal therapy is indicated, and valve replacement is often necessary.