Bacterial endocarditis in hemodialysis patients.

Published

Journal Article

Infective endocarditis (IE) is one of the most serious complications of bacteremia. Hemodialysis patients with prosthetic vascular access devices such as dual-lumen cuffed venous catheters and polytetrafluoroethylene (PTFE) grafts are at increased risk for bacteremia compared with patients with primary arteriovenous fistulae (PAVF). We present 20 cases of IE in hemodialysis patients seen at our institution over a 7-year period. Eight patients had PTFE grafts, 11 had dual-lumen cuffed catheters, and one had a PAVF. All patients underwent transthoracic echocardiography (TTE) and 16 patients also received transesophageal echocardiography (TEE). The Duke Criteria were used to characterize patients as definite or possible IE. Organisms were Staphylococcus aureus (55%), Staphylococcus epidermidis (25%), and Enterococcus sp (10%). The mitral valve (50%) was the most commonly affected valve, followed by aortic (30%) and right-sided IE (25%). Valve replacement was performed in five patients, of whom three survived hospitalization. The overall mortality rate for the series was 30%. All the dual-lumen cuffed catheters were removed, while only two of the eight PTFE grafts were removed. Four of the six patients who died had PTFE grafts, of which one was judged to be infected and removed. Echocardiography was essential to the diagnosis of IE. Vegetations were found in 50% by TTE and 81% by TEE. Six patients with no vegetations on TTE were found to have vegetations on TEE.

Full Text

Duke Authors

Cited Authors

  • Robinson, DL; Fowler, VG; Sexton, DJ; Corey, RG; Conlon, PJ

Published Date

  • October 1997

Published In

Volume / Issue

  • 30 / 4

Start / End Page

  • 521 - 524

PubMed ID

  • 9328367

Pubmed Central ID

  • 9328367

International Standard Serial Number (ISSN)

  • 0272-6386

Digital Object Identifier (DOI)

  • 10.1016/s0272-6386(97)90311-5

Language

  • eng

Conference Location

  • United States