Bacterial endocarditis in regularly dialyzed patients

Abstract

Nine patients developed bacterial endocarditis during maintenance dialysis (2.7% of all patients so treated). Probable causative organisms included staphylococci (5), Listeria (2), Corynebacterium (1), and enterococci (1). On the average, endocarditis was detected 28.6 mths after dialysis was initiated. Antecedent vascular access infections were common, as were central nervous system symptoms. Peripheral embolic phenomena were infrequent. The aortic valve was usually involved. Underlying heart disease was frequent and facilitated the appearance of congestive heart failure. Heart failure and valvular perforation usually caused death. Antibiotic therapy was ineffective in most patients. Only 2 of the patients survived, one of whom had aortic valve replacement. Death due to endocarditis occurred in 2 of 3 patients with osteomyelitis and 2 of 3 patients receiving adrenocorticosteroid therapy. The clinical presentation of bacterial endocarditis, its clinical course and outcome, and the urgency for treatment differ substantially from those in nonuremic patients.