Introduction:
Infective endocarditis (IE) is a serious cardiovascular complication associated with high morbidity and mortality. Currently, it is recognized that the incidence of IE in chronic hemodialysis (CHD) patients is high compared to the general population. IE pathophysiology involves three critical elements: the presence of a valvular anomaly, the adherence of a microorganism to the abnormal valve and its dissemination to distant sites. Valvular calcifications due to mineral and bone disorders, bacteremia related to vascular access infections, and immune system dysregulation therefore appear to be factors exposing CHD patients to the risk of IE.
Methods:
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.
Results:
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).
Conclusions:
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.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.