Abstract
Background and Aims
Infectious complications are the second leading cause of death in hemodialysis patients. This population is particularly exposed to bacteremia, on the one hand, because of the vascular access necessary for hemodialysis, which is a gateway to the various micro-organisms, and on the other hand, factors of susceptibility to infections. Infective endocarditis (IE) is the cardiac endothelium infection associated with bacteremia. It is a rare complication but its mortality remains high especially in patients on chronic hemodialysis.
The aim of this study was to determine the microbiological profile, clinical and-biological profile, characteristics in the ultrasound, therapeutic modalities, and prognosis of IE in hemodialysis.
Method
This is a retrospective descriptive study of including chronic hemodialysis patients, admitted in the Nephrology and Internal Medicine Department A of the Charles Nicolle Hospital in Tunis for an IE during the period from 1973 to 2018. We used the modified Duke criteria to confirm the diagnosis of IE.
Results
Nineteen patients were included, including 12 men and 7 women (gender ratio=1.7). The average age was 49.1 years [29-66 years]. Seven of them (37%) were known to have a valvular disease, two of them had a double mitro-aortic valve replacement. Six of them (32%) were diabetic and two patients (11%) were on immunosuppressive therapy. The vascular access initially used for HD were arteriovenous fistula in 9 cases (47%), internal jugular catheter in 3 cases (16%), subclavian catheter in 1 case (5%), Canaud catheter in 3 cases (16%), and 2 patients were dialyzed by femoral catheter (11%). Clinically, all patients had an altered general condition, fever was present in 14 cases (74%) and a heart murmur in 10 cases (53%). Blood cultures were positive in 14 cases (74%). The isolated germs were Staphylococcus Aureus in 8 cases, Staphylococcus epidermidis in 4 cases, Pseudomonas aerogenosa in 3 cases, Enterobacterium in 1 case, enterococcus faecalis in 1 case, and Klebsielle oxytoca in one patient. On cardiac ultrasound, mitral valve damage was found in 10 patients, aortic sigmoid in 4 patients and tricuspid valve in 3 patients. The treatment included appropriate antibiotic therapy in all cases and a valvuloplasty was indicated in 7 patients. Nine patients (47%) died during their hospitalization.
Conclusion
Hemodialysis patients are particularly exposed to IE. The most appropriate preventive method is the strict observance of asepsis when handling the vascular access first and the rapid eradication of all infectious outbreaks.
Surviving a Rare Complication of Infective Endocarditis