Bacterial endocarditis in hemodialysis patients

Area of Science:

• Nephrology
• Infectious Diseases
• Cardiology

Background:

• Infective endocarditis (IE) is a severe complication of bacteremia.
• Hemodialysis patients with prosthetic vascular access devices (e.g., PTFE grafts, dual-lumen catheters) face higher bacteremia risk than those with primary arteriovenous fistulae (PAVF).

Purpose of the Study:

• To analyze the characteristics, management, and outcomes of infective endocarditis in hemodialysis patients.
• To evaluate the role of different vascular access types in IE development and outcomes.

Main Methods:

• Retrospective case series of 20 hemodialysis patients with IE over 7 years.
• Diagnosis confirmed using Duke Criteria, supported by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE).
• Analysis of causative organisms, affected valves, treatment interventions, and mortality rates.

Main Results:

• Staphylococcus aureus was the most common pathogen (55%).
• Mitral valve (50%) and aortic valve (30%) were most frequently affected.
• Overall mortality was 30%; dual-lumen catheters were removed, but PTFE graft removal was less common, with higher mortality associated with grafts.
• TEE detected vegetations in 81% of cases, significantly more than TTE (50%).

Conclusions:

• Infective endocarditis poses a significant threat to hemodialysis patients, particularly those with prosthetic vascular access.
• Echocardiography, especially TEE, is vital for diagnosing IE in this population.
• Management strategies, including device removal and valve surgery, impact survival, highlighting the need for careful consideration of vascular access type.