[Infectious endocarditis in patients on periodic hemodialysis]

Nineteen patients originating from four hemodialysis centers with infectious endocarditis (IE) were studied during the period of 1985-1989. It was observed high proportion of patients with apparent normal cardiac valves preceding the IE; in 68.42% (13 out of 19 cases) there was an association with vascular access infection, the dialysis treatment time had a variation from 5 days to 6 years (median 19.5 months) and the interval between the initial symptoms and the IE diagnosis was from 2 to 30 days with an average of 5 days. The echocardiogram showed vegetation in 18 cases studied. The mostly affected cardiac valves were mitral in 42.1% and aortic in 31.5%. The predominant organism was S. aureus (75%). In 8 cases the primary focus was identified as the hemodialysis catheter and in 6 others as the arteriovenous fistula, one patient presented infection in both access simultaneously. The outstanding clinical manifestations were embolic (12 out of 19 cases) neurological (13 out of 19) and of cardiac failure (13 out of 19). The median hospitalization time was 24 days (4-55 days) and the mortality rate was 68.4%, the majority of sepsis. The authors emphasize the large proportion of cases linked to hemodialysis catheters and propose an increase in the infectious preventive measurements in those patients.