Emanuele Durante-Mangoni1,2, Pia Clara Pafundi3, Veronica Ravasio4, Francesco Barbaro5, Matteo Bassetti6, Pierangelo Chinello7, Marco Falcone8, Maria Bruna Pasticci9, Pier Giorgio Scotton10, Roberto Stellini11, Marie-Françoise Tripodi12, Riccardo Utili3, Marco Rizzi4. 1. Internal Medicine, Monaldi Hospital, University of Naples SUN, Naples, Italy. emanuele.durante@unina2.it. 2. Second University of Naples c/o Ospedale Monaldi, Via L. Bianchi, 80131, Naples, Italy. emanuele.durante@unina2.it. 3. Internal Medicine, Monaldi Hospital, University of Naples SUN, Naples, Italy. 4. Infectious Diseases, Papa Giovanni XXIII Hospital, Bergamo, Italy. 5. Infectious Diseases, Padua University Hospital, Padua, Italy. 6. Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy. 7. 2nd Division of Infectious Diseases, INMI 'L. Spallanzani', Rome, Italy. 8. Department of Public Health, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy. 9. Infectious Diseases, University of Perugia, Perugia, Italy. 10. Infectious Diseases, S. Maria di Ca' Foncello Hospital, Treviso, Italy. 11. Infectious Diseases, University of Brescia, Brescia, Italy. 12. Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
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.
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:HDpatients 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 HDpatients and 36.5 % of no-HDpatients (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 HDpatients with IE.
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