Infective endocarditis in hemodialysis patients: clinical features, echocardiographic data and outcome: a 10-year descriptive analysis.

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.