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Infective Endocarditis in Chronic Hemodialysis Patients: A Review Article for Assessment and Treatment

Öykü Gülmez

Infective Endocarditis (IE) is a life-threating condition especially in patients with end-stage renal disease (ESRD). It has been particularly associated with recurrent bacteremia because of vascular access via dual lumen catheters. Patients with ESRD receiving hemodialysis (HD) are prone to metastatic bloodstream infections and the calcified or degenerative mitral valve (up to 50% of cases) is more frequently affected than aortic valve. The most common pathogen is S. aureus. Methicillin-susceptible S. aureus (MSSA) accounts for 33% of the cases whereas methicillin-resistant S. aureus (MRSA) accounts for 25% of the cases. The diagnosis of IE in patients with ESRD using Duke Criteria is problematic since the clinical presentation usually resembles to an access infection. Mortality still remains high with reported rates ranging from 30% to 50%. Mitral valve involvements, septic embolism, IE related to drug resistant organisms are the mortality risk factors in this population. Transthoracic echocardiography as well as trans esophageal echocardiography should always planned in any ESRD patient with suspicion of IE. Appropriate antibiotic treatment and duration as well as surgery in selected cases should be considered according to the guidelines. Anti-staphylococcal penicillin or first generation cephalosporin should be selected for MSSA. Coversly, vancomycin should be selected for MRSA. Strict hygiene, cleaning the site and sterile techniques when accessing artriovenous fistulas or vascular catheters can minimize the potential for infection.