Current features of infective endocarditis in persons on hemodialysis: a prevalence study with case control design from the prospective multicenter SEI cohort

Emanuele Durante-Mangoni, Pia Clara Pafundi, Veronica Ravasio, Francesco Barbaro, Matteo Bassetti, Pierangelo Chinello, Marco Falcone, Maria Bruna Pasticci, Pier Giorgio Scotton, Roberto Stellini, Marie Françoise Tripodi, Riccardo Utili, Marco Rizzi

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Persons on hemodialysis (HD) are at high risk of infective endocarditis (IE). In non-comparative retrospective studies, a higher rate of mortality was reported in IE on HD. We assessed risk factors, clinical characteristics, and outcomes of IE in HD. Methods: This was a prevalence study with a case control methodology on a set of data from the prospectively followed cohort of the Studio Endocarditi Italiano (SEI), conducted between 2004 and 2011. Included were 42 consecutive cases of IE HD subjects and 126 controls not on HD, matched for age, sex, type of IE, and heart side involved. Clinical, echocardiographic, microbiological features, and disease complications and therapeutic modalities were assessed. Results: HD patients were more often diabetics (42.9 vs 18.2 % in no-HD; p = 0.007) and immune-suppressed (16.7 vs 3.2 %; p = 0.02), and had a higher rate of predisposing cardiac conditions (45 vs 25 %; p = 0.031). A higher prevalence of health care-related acquisition and a shorter diagnostic delay was observed in IE on HD, that was more likely to be caused by staphylococci and less by streptococci (p <0.002). Cardiac surgery was performed in 38 % of HD patients and 36.5 % of no-HD patients (p = 0.856). Complications were similar and in-hospital mortality did not differ significantly (26.2 % in HD vs 15.9 % in no-HD; p = 0.168). Conclusions: IE in persons on HD is characterized by distinctive clinical features, including a higher prevalence of some important comorbidities. Inconsistent with prior studies, we could not confirm a higher rate of complications and mortality in HD patients with IE.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalInfection
DOIs
Publication statusAccepted/In press - Jan 19 2016

Keywords

  • Case–control study
  • Endocarditis
  • Hemodialysis
  • Risk factors
  • Staphylococcus aureus

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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