MP643INFECTIVE ENDOCARDITIS IN CHRONIC HEMODIALYSIS PATIENTS - SINGLE CENTER EXPERIENCE

Abstract

Introduction and Aims: Infections are the second leading cause of death in the chronic hemodialysis (HD) patients. This population is predisposed to infection secondary to transient bacteriemia due to repetitive manipulation of the vascular access. Also, they have a poor imune sistem secondary to uremic status. Infective endocarditis (IE) is a commom and serious complication in chronic HD patients, and it is associated with greater morbi-mortality than in general population. Methods: Single center retrospective analysis of all cases of IE (using the Duke criteria) in chronic HD patients between january-2000 to december-2015. Patients were followed up for one month after hospital discharge. Results: Twenty-eight patients were identified as having IE (29 episodes of IE). Mean age was 62.6 years, 53,5% were male and mean duration of HD prior to IE was 24,5 months. Primary HD access was dual-lumen tunneled catheter (DLTC) in 53,6%, an arteriouvenous fistula (AVF) in 25% and a polytetrafluoroethylene (PTFE) graft in 21,4%. Almost all patients presented with fever and increase in serum inflamatory parameters. A previous infectious episode (< 6 months) was present in 58.6% of cases and in 70.6% of those it was related to vascular access. Predominant organism was Staphylococcus aureus in 37,9% of cases. The mitral valve was affected in 44,8%, aortic valve in 37,9%, tricuspid valve in 13.8% and more than one affected valve was present in 10.3% of cases. Of note, 37.9% of patients han an abnormal valve before the IE episode and 28,5% of patients were diabetic. In the majority of cases, two or more antibiotic were performed, for a medium of 5.7 weeks. Only in 2 cases surgery was undertaken. Medium duration of hospital stay was 55.7 days. Overall hospital mortality was 17% and 75% survived for 30 days. Conclusions: The prognosis of IE in chronic HD patients is poor. Although most commonly affects patients with DLTC it also affects patients with AVF or PTFE. Importantly, in most cases an episode of infection prior to IE was possible to identify. Better infection surveillance and vascular access care might decrease the morbidity and mortality associated with this disorder.