Infective endocarditis in hemodialysis patients: clinical features, echocardiographic data and outcome

Background  Infective endocarditis (IE) is a dreaded complication in hemodialysis (HD) patients and is strongly associated with morbidity and mortality. Objectives  Our aim was to investigate clinical and echocardiographic characteristics, microbiological profile, management and outcome of patients on HD in a Tunisian (Tunisia, North Africa) high-volume tertiary-care centre. Methods  Among 182 patients who fulfilled the modified Duke criteria for infective endocarditis between January 1997 and December 2006, 16 were on chronic HD and were included in the study. Results  Mean age was 52.5 ± 22.3 years, ten were male and arteriovenous fistulas were the most commonly used access sites (12 out of 16 cases). Average duration of dialysis was 27.3 ± 30 months. Major causative organisms were Staphylococcus species (including methicillin-resistant Staphylococcus aureus) in 11 (68.7%) of the 16 cases. The mitral valve was the most commonly affected 9 patients out of 16 (56.2%)], followed by aortic valve in 4 cases (25.0%) and tricuspid valve in 1 case (6.2%). Complications were frequent, including congestive heart failure (56.2%), secondary septic localisations (31.2%), arterial emboli (18.7%), and cerebral haemorrhage (6.2%). Five patients underwent surgery and seven died during hospitalization (43.7% mortality rate). No recurrences of IE were recorded in the nine survivors after average 21.7 ± 17.3 months follow-up. Conclusion  In this largest reported confirmed IE series in dialysis patients in a developing country, mortality was very high; mitral valve was the most commonly affected valve. Staphylococcus species were the major causative organisms.