Infective Endocarditis in Chronic Hemodialysis Patients: Specificities and Therapeutic Management

Abstract

Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. 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. 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). 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.