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Related Concept Videos

Endocarditis I: Introduction01:25

Endocarditis I: Introduction

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Introduction:Endocarditis is the infection of the endocardium, the inner lining of the heart and its valves. When the heart muscle is involved, the condition is termed myocarditis, while an infection of the outer lining is called pericarditis. Infective endocarditis (IE) primarily affects the endocardium, where pathogens adhere to the valves or lining, forming vegetation that can lead to severe complications. Infective endocarditis occurs when microorganisms, usually bacteria from other body...
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Endocarditis IV: Nursing Management01:29

Endocarditis IV: Nursing Management

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Infective endocarditis (IE) is a chronic infection of the heart's endocardium, primarily affecting the heart valves. A detailed nursing assessment for a patient with IE involves collecting subjective and objective data to ensure an accurate diagnosis and timely intervention.Subjective DataThe nurse gathers information about the patient's symptoms and complaints during the subjective assessment. Patients with infective endocarditis often report non-specific symptoms that can mimic other...
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Endocarditis II: Clinical Features of Infective Endocarditis01:25

Endocarditis II: Clinical Features of Infective Endocarditis

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Endocarditis can present various clinical features depending on the causative organism and the patient's underlying health conditions. Initially, the clinical features of infective endocarditis develop gradually, presenting with nonspecific symptoms that can be easily mistaken for other illnesses.General SymptomsEarly symptoms of infective endocarditis are fever, chills, weakness, malaise, fatigue, and weight loss. These symptoms reflect the systemic nature of the infection and the body's...
109
Endocarditis III: Medical Management01:18

Endocarditis III: Medical Management

81
Infective endocarditis management involves a multifaceted approach encompassing infection prevention, lifestyle modifications, pharmacological therapy, and surgical management.Infection Prevention:Hand Hygiene: Thorough handwashing is crucial to prevent the spread of infection. Hand hygiene should be performed regularly, especially before and after using the restroom.Oral Hygiene: Good oral hygiene is essential. It includes brushing teeth immediately after waking up and before bed, flossing...
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Hemodialysis II: Procedure and Complications01:24

Hemodialysis II: Procedure and Complications

266
DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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Hemodialysis I: Introduction01:25

Hemodialysis I: Introduction

632
Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
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Infective Endocarditis in Patients on Chronic Hemodialysis.

Juan M Pericàs1, Jaume Llopis2, Maria Jesús Jiménez-Exposito1

  • 1Infectious Diseases Service, Hospital Clínic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.

Journal of the American College of Cardiology
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Summary

Infective endocarditis in patients on chronic hemodialysis has significantly higher mortality and relapse rates compared to non-dialysis patients. Cardiac surgery is performed less often in hemodialysis patients with infective endocarditis.

Keywords:
Staphylococcus aureuscardiac surgeryenterococcihemodialysisinfective endocarditisrelapses

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Area of Science:

  • Cardiology
  • Nephrology
  • Infectious Diseases

Background:

  • Infective endocarditis (IE) is a serious complication for patients undergoing chronic hemodialysis (HD).
  • Understanding the differences in IE outcomes between HD and non-HD patients is crucial for clinical management.

Purpose of the Study:

  • To compare complications, cardiac surgery rates, relapses, and mortality in IE patients with and without chronic HD.
  • To identify risk factors for adverse outcomes in HD patients with IE.

Main Methods:

  • A prospective cohort study using the International Collaboration on Endocarditis databases (2000-2006, 2008-2012).
  • Analysis included 6,691 IE episodes, comparing 553 HD patients with non-HD patients.
  • Multivariable logistic regression identified risk factors for mortality and major events in HD patients.

Main Results:

  • In-hospital and 6-month mortality were significantly higher in HD patients (30.4% vs. 17% and 39.8% vs. 20.7%).
  • Relapses were more frequent in HD patients (9.4% vs. 2.7%), while cardiac surgery was less frequent (30.6% vs. 46.2%).
  • Risk factors for mortality in HD patients included higher Charlson score, CNS emboli, persistent bacteremia, and acute heart failure.

Conclusions:

  • Hemodialysis-associated infective endocarditis (HD-IE) is often caused by Staphylococcus aureus and increasingly by enterococci.
  • HD-IE patients face higher mortality and relapse rates but undergo less cardiac surgery compared to non-HD-IE patients.
  • Healthcare-associated infections like HD-IE require targeted prevention and management strategies.