Infective Endocarditis in Patients on Chronic Hemodialysis

Juan M. Pericas; Jaume Llopis; Maria Jesús Jiménez-Exposito; Wissam M. Kourany; Benito Almirante; Giampiero Carosi; Emanuele Durante-Mangoni; Claudio Querido Fortes; Efthymia Giannitsioti; Stamatios Lerakis; Rodrigo Montagna-Mella; Juan Ambrosioni; Ru San Tan; Carlos A. Mestres; Dannah Wray; Orathai Pachirat; Asuncion Moreno; Vivian H. Chu; Elisa de Lazzari; Vance G. Fowler; Jose M. Miró; ICE Investigators; David Gordon; Lito Papanicolas; Phillip Jones; David Rees; Emanuele Durante-Mangoni

doi:10.1016/j.jacc.2021.02.014

Infective Endocarditis in Patients on Chronic Hemodialysis

Juan M. Pericas, Jaume Llopis, Maria Jesús Jiménez-Exposito, Wissam M. Kourany, Benito Almirante, Giampiero Carosi, Emanuele Durante-Mangoni, Claudio Querido Fortes, Efthymia Giannitsioti, Stamatios Lerakis, Rodrigo Montagna-Mella, Juan Ambrosioni, Ru San Tan, Carlos A. Mestres, Dannah Wray, Orathai Pachirat, Asuncion Moreno, Vivian H. Chu, Elisa de Lazzari, Vance G. FowlerJose M. Miró, ICE Investigators, David Gordon, Lito Papanicolas, Phillip Jones, David Rees, Emanuele Durante-Mangoni

College of Medicine and Public Health

Research output: Contribution to journal › Article › peer-review

32 Citations (Scopus)

Abstract

Background: Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). Objectives: This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients. Methods: Prospective cohort study (International Collaboration on Endocarditis databases, encompassing 7,715 IE episodes from 2000 to 2006 and from 2008 to 2012). Descriptive analysis of baseline characteristics, epidemiological and etiological features, complications and outcomes, and their comparison between HD and non-HD patients was performed. Risk factors for major embolic events, cardiac surgery, relapses, and in-hospital and 6-month mortality were investigated in HD-patients using multivariable logistic regression. Results: A total of 6,691 patients were included and 553 (8.3%) received HD. North America had a higher HD-IE proportion than the other regions. The predominant microorganism was Staphylococcus aureus (47.8%), followed by enterococci (15.4%). Both in-hospital and 6-month mortality were significantly higher in HD versus non–HD-IE patients (30.4% vs. 17% and 39.8% vs. 20.7%, respectively; p < 0.001). Cardiac surgery was less frequently performed among HD patients (30.6% vs. 46.2%; p < 0.001), whereas relapses were higher (9.4% vs. 2.7%; p < 0.001). Risk factors for 6-month mortality included Charlson score (hazard ratio [HR]: 1.26; 95% confidence interval [CI]: 1.11 to 1.44; p = 0.001), CNS emboli and other emboli (HR: 3.11; 95% CI: 1.84 to 5.27; p < 0.001; and HR: 1.73; 95% CI: 1.02 to 2.93; p = 0.04, respectively), persistent bacteremia (HR: 1.79; 95% CI: 1.11 to 2.88; p = 0.02), and acute onset heart failure (HR: 2.37; 95% CI: 1.49 to 3.78; p < 0.001). Conclusions: HD-IE is a health care–associated infection chiefly caused by S. aureus, with increasing rates of enterococcal IE. Mortality and relapses are very high and significantly larger than in non–HD-IE patients, whereas cardiac surgery is less frequently performed.

Original language	English
Pages (from-to)	1629-1640
Number of pages	12
Journal	Journal of The American College of Cardiology
Volume	77
Issue number	13
DOIs	https://doi.org/10.1016/j.jacc.2021.02.014
Publication status	Published - 6 Apr 2021

Keywords

cardiac surgery
enterococci
hemodialysis
infective endocarditis
relapses
Staphylococcus aureus

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Pericas, J. M., Llopis, J., Jiménez-Exposito, M. J., Kourany, W. M., Almirante, B., Carosi, G., Durante-Mangoni, E., Fortes, C. Q., Giannitsioti, E., Lerakis, S., Montagna-Mella, R., Ambrosioni, J., Tan, R. S., Mestres, C. A., Wray, D., Pachirat, O., Moreno, A., Chu, V. H., de Lazzari, E., ... Durante-Mangoni, E. (2021). Infective Endocarditis in Patients on Chronic Hemodialysis. Journal of The American College of Cardiology, 77(13), 1629-1640. https://doi.org/10.1016/j.jacc.2021.02.014

@article{1ffc82601f1c4b9c8360f299a9bc49f8,

title = "Infective Endocarditis in Patients on Chronic Hemodialysis",

abstract = "Background: Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). Objectives: This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients. Methods: Prospective cohort study (International Collaboration on Endocarditis databases, encompassing 7,715 IE episodes from 2000 to 2006 and from 2008 to 2012). Descriptive analysis of baseline characteristics, epidemiological and etiological features, complications and outcomes, and their comparison between HD and non-HD patients was performed. Risk factors for major embolic events, cardiac surgery, relapses, and in-hospital and 6-month mortality were investigated in HD-patients using multivariable logistic regression. Results: A total of 6,691 patients were included and 553 (8.3%) received HD. North America had a higher HD-IE proportion than the other regions. The predominant microorganism was Staphylococcus aureus (47.8%), followed by enterococci (15.4%). Both in-hospital and 6-month mortality were significantly higher in HD versus non–HD-IE patients (30.4% vs. 17% and 39.8% vs. 20.7%, respectively; p < 0.001). Cardiac surgery was less frequently performed among HD patients (30.6% vs. 46.2%; p < 0.001), whereas relapses were higher (9.4% vs. 2.7%; p < 0.001). Risk factors for 6-month mortality included Charlson score (hazard ratio [HR]: 1.26; 95% confidence interval [CI]: 1.11 to 1.44; p = 0.001), CNS emboli and other emboli (HR: 3.11; 95% CI: 1.84 to 5.27; p < 0.001; and HR: 1.73; 95% CI: 1.02 to 2.93; p = 0.04, respectively), persistent bacteremia (HR: 1.79; 95% CI: 1.11 to 2.88; p = 0.02), and acute onset heart failure (HR: 2.37; 95% CI: 1.49 to 3.78; p < 0.001). Conclusions: HD-IE is a health care–associated infection chiefly caused by S. aureus, with increasing rates of enterococcal IE. Mortality and relapses are very high and significantly larger than in non–HD-IE patients, whereas cardiac surgery is less frequently performed.",

keywords = "cardiac surgery, enterococci, hemodialysis, infective endocarditis, relapses, Staphylococcus aureus",

author = "Pericas, {Juan M.} and Jaume Llopis and Jim{\'e}nez-Exposito, {Maria Jes{\'u}s} and Kourany, {Wissam M.} and Benito Almirante and Giampiero Carosi and Emanuele Durante-Mangoni and Fortes, {Claudio Querido} and Efthymia Giannitsioti and Stamatios Lerakis and Rodrigo Montagna-Mella and Juan Ambrosioni and Tan, {Ru San} and Mestres, {Carlos A.} and Dannah Wray and Orathai Pachirat and Asuncion Moreno and Chu, {Vivian H.} and {de Lazzari}, Elisa and Fowler, {Vance G.} and Mir{\'o}, {Jose M.} and {ICE Investigators} and Liliana Clara and Marisa Sanchez and Jos{\'e} Casab{\'e} and Claudia Cortes and Francisco Nacinovich and Oses, {Pablo Fernandez} and Ricardo Ronderos and Adriana Sucari and Jorge Thierer and Javier Altclas and Silvia Kogan and Denis Spelman and Eugene Athan and Owen Harris and Karina Kennedy and Ren Tan and David Gordon and Lito Papanicolas and Tony Korman and Despina Kotsanas and Robyn Dever and Phillip Jones and Pam Konecny and Richard Lawrence and David Rees and Suzanne Ryan and Feneley, {Michael P.} and John Harkness and Jeffrey Post and Porl Reinbott and Rainer Gattringer and Franz Wiesbauer and Andrade, {Adriana Ribas} and {Passos de Brito}, {Ana Cl{\'a}udia} and Guimar{\~a}es, {Armenio Costa} and Max Grinberg and Mansur, {Alfredo Jos{\'e}} and Siciliano, {Rinaldo Focaccia} and {Varejao Strabelli}, {Tania Mara} and {Campos Vieira}, {Marcelo Luiz} and {de Medeiros Tranchesi}, {Regina Aparecida} and Paiva, {Marcelo Goulart} and {de Oliveira Ramos}, Auristela and Clara Weksler and Giovanna Ferraiuoli and Wilma Golebiovski and Cristiane Lamas and Karlowsky, {James A.} and Yoav Keynan and Morris, {Andrew M.} and Ethan Rubinstein and Jones, {Sandra Braun} and Patricia Garcia and M. Cereceda and Alberto Fica and Mella, {Rodrigo Montagna} and Ricardo Fernandez and Liliana Franco and Javier Gonzalez and Jaramillo, {Astrid Natalia} and Bruno Barsic and Suzana Bukovski and Vladimir Krajinovic and Ana Pangercic and Igor Rudez and Josip Vincelj and Tomas Freiberger and Jiri Pol and Barbora Zaloudikova and Zainab Ashour and {El Kholy}, Amani and Marwa Mishaal and Dina Osama and Hussien Rizk and Neijla Aissa and Corentine Alauzet and Francois Alla and Campagnac, {CHU Catherine} and Thanh Doco-Lecompte and Christine Selton-Suty and Casalta, {Jean Paul} and Fournier, {Pierre Edouard} and Gilbert Habib and Didier Raoult and Franck Thuny and Francois Delahaye and Armelle Delahaye and Francois Vandenesch and Erwan Donal and Donnio, {Pierre Yves} and Erwan Flecher and Christian Michelet and Matthieu Revest and Pierre Tattevin and Florent Chevalier and Antoine Jeu and R{\'e}madi, {Jean Paul} and Dan Rusinaru and Christophe Tribouilloy and Yvette Bernard and Catherine Chirouze and Bruno Hoen and Joel Leroy and Patrick Plesiat and Christoph Naber and Carl Neuerburg and Bahram Mazaheri and {Sophia Athanasia}, {Carl Neuerburg} and Ioannis Deliolanis and Helen Giamarellou and Tsaganos Thomas and Elena Mylona and Olga Paniara and Konstantinos Papanicolaou and John Pyros and Athanasios Skoutelis and Konstantinos Papanikolaou and Gautam Sharma and Johnson Francis and Lathi Nair and Vinod Thomas and Krishnan Venugopal and Hannan, {Margaret M.} and Hurley, {John P.} and Maor Wanounou and Dan Gilon and Sarah Israel and Maya Korem and Jacob Strahilevitz and Emanuele Durante-Mangoni and Domenico Iossa and Serena Orlando and Ursi, {Maria Paola} and Pafundi, {Pia Clara} and Fabiana D'Amico and Mariano Bernardo and Susanna Cuccurullo and Giovanni Dialetto and Covino, {Franco Enrico} and Sabrina Manduca and {Della Corte}, Alessandro and {De Feo}, Marisa and Tripodi, {Marie Fran{\c c}oise} and Enrico Cecchi and {De Rosa}, Francesco and Davide Forno and Massimo Imazio and Rita Trinchero and Paolo Grossi and Mariangela Lattanzio and Antonio Toniolo and Antonio Goglio and Annibale Raglio and Veronica Ravasio and Marco Rizzi and Fredy Suter and Silvia Magri and Liana Signorini and Zeina Kanafani and Kanj, {Souha S.} and Ahmad Sharif-Yakan and Imran Abidin and Tamin, {Syahidah Syed} and Mart{\'i}nez, {Eduardo Rivera} and {Soto Nieto}, {Gabriel Israel} and {van der Meer}, {Jan T.M.} and Stephen Chambers and David Holland and Arthur Morris and Nigel Raymond and Kerry Read and Murdoch, {David R.} and Stefan Dragulescu and Adina Ionac and Cristian Mornos and Butkevich, {O. M.} and Natalia Chipigina and Ozerecky Kirill and Kulichenko Vadim and Tatiana Vinogradova and Jameela Edathodu and Magid Halim and Liew, {Yee Yun} and Tatjana Lejko-Zupanc and Mateja Logar and Manica Mueller-Premru and Patrick Commerford and Anita Commerford and Eduan Deetlefs and Cass Hansa and Mpiko Ntsekhe and Manel Almela and Manuel Azqueta and Merce Brunet and Pedro Castro and Carlos Falces and David Fuster and Guillermina Fita and {Garcia- de- la- Maria}, Cristina and Javier Garcia-Gonzalez and Gatell, {Jose M.} and Francesc Marco and Mir{\'o}, {Jos{\'e} M.} and Jos{\'e} Ortiz and Salvador Ninot and Par{\'e}, {J. Carlos} and Pericas, {Juan M.} and Eduard Quintana and Jose Ramirez and Irene Rovira and Elena Sandoval and Marta Sitges and Adrian Tellez and Tolosana, {Jos{\'e} M.} and Barbara Vidal and Jordi Vila and Ignasi Anguera and Bernat Font and Guma, {Joan Raimon} and Javier Bermejo and Emilio Bouza and {Garcia Fern{\'a}ndez}, {Miguel Angel} and Victor Gonzalez-Ramallo and Mercedes Mar{\'i}n and Patricia Mu{\~n}oz and Miguel Pedromingo and Jorge Roda and Marta Rodr{\'i}guez-Cr{\'e}ixems and Jorge Solis and Nuria Fernandez-Hidalgo",

year = "2021",

month = apr,

day = "6",

doi = "10.1016/j.jacc.2021.02.014",

language = "English",

volume = "77",

pages = "1629--1640",

journal = "Journal of The American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "13",

}

Pericas, JM, Llopis, J, Jiménez-Exposito, MJ, Kourany, WM, Almirante, B, Carosi, G, Durante-Mangoni, E, Fortes, CQ, Giannitsioti, E, Lerakis, S, Montagna-Mella, R, Ambrosioni, J, Tan, RS, Mestres, CA, Wray, D, Pachirat, O, Moreno, A, Chu, VH, de Lazzari, E, Fowler, VG, Miró, JM, ICE Investigators, Gordon, D, Papanicolas, L, Jones, P, Rees, D & Durante-Mangoni, E 2021, 'Infective Endocarditis in Patients on Chronic Hemodialysis', Journal of The American College of Cardiology, vol. 77, no. 13, pp. 1629-1640. https://doi.org/10.1016/j.jacc.2021.02.014

TY - JOUR

T1 - Infective Endocarditis in Patients on Chronic Hemodialysis

AU - Pericas, Juan M.

AU - Llopis, Jaume

AU - Jiménez-Exposito, Maria Jesús

AU - Kourany, Wissam M.

AU - Almirante, Benito

AU - Carosi, Giampiero

AU - Durante-Mangoni, Emanuele

AU - Fortes, Claudio Querido

AU - Giannitsioti, Efthymia

AU - Lerakis, Stamatios

AU - Montagna-Mella, Rodrigo

AU - Ambrosioni, Juan

AU - Tan, Ru San

AU - Mestres, Carlos A.

AU - Wray, Dannah

AU - Pachirat, Orathai

AU - Moreno, Asuncion

AU - Chu, Vivian H.

AU - de Lazzari, Elisa

AU - Fowler, Vance G.

AU - Miró, Jose M.

AU - ICE Investigators

AU - Clara, Liliana

AU - Sanchez, Marisa

AU - Casabé, José

AU - Cortes, Claudia

AU - Nacinovich, Francisco

AU - Oses, Pablo Fernandez

AU - Ronderos, Ricardo

AU - Sucari, Adriana

AU - Thierer, Jorge

AU - Altclas, Javier

AU - Kogan, Silvia

AU - Spelman, Denis

AU - Athan, Eugene

AU - Harris, Owen

AU - Kennedy, Karina

AU - Tan, Ren

AU - Gordon, David

AU - Papanicolas, Lito

AU - Korman, Tony

AU - Kotsanas, Despina

AU - Dever, Robyn

AU - Jones, Phillip

AU - Konecny, Pam

AU - Lawrence, Richard

AU - Rees, David

AU - Ryan, Suzanne

AU - Feneley, Michael P.

AU - Harkness, John

AU - Post, Jeffrey

AU - Reinbott, Porl

AU - Gattringer, Rainer

AU - Wiesbauer, Franz

AU - Andrade, Adriana Ribas

AU - Passos de Brito, Ana Cláudia

AU - Guimarães, Armenio Costa

AU - Grinberg, Max

AU - Mansur, Alfredo José

AU - Siciliano, Rinaldo Focaccia

AU - Varejao Strabelli, Tania Mara

AU - Campos Vieira, Marcelo Luiz

AU - de Medeiros Tranchesi, Regina Aparecida

AU - Paiva, Marcelo Goulart

AU - de Oliveira Ramos, Auristela

AU - Weksler, Clara

AU - Ferraiuoli, Giovanna

AU - Golebiovski, Wilma

AU - Lamas, Cristiane

AU - Karlowsky, James A.

AU - Keynan, Yoav

AU - Morris, Andrew M.

AU - Rubinstein, Ethan

AU - Jones, Sandra Braun

AU - Garcia, Patricia

AU - Cereceda, M.

AU - Fica, Alberto

AU - Mella, Rodrigo Montagna

AU - Fernandez, Ricardo

AU - Franco, Liliana

AU - Gonzalez, Javier

AU - Jaramillo, Astrid Natalia

AU - Barsic, Bruno

AU - Bukovski, Suzana

AU - Krajinovic, Vladimir

AU - Pangercic, Ana

AU - Rudez, Igor

AU - Vincelj, Josip

AU - Freiberger, Tomas

AU - Pol, Jiri

AU - Zaloudikova, Barbora

AU - Ashour, Zainab

AU - El Kholy, Amani

AU - Mishaal, Marwa

AU - Osama, Dina

AU - Rizk, Hussien

AU - Aissa, Neijla

AU - Alauzet, Corentine

AU - Alla, Francois

AU - Campagnac, CHU Catherine

AU - Doco-Lecompte, Thanh

AU - Selton-Suty, Christine

AU - Casalta, Jean Paul

AU - Fournier, Pierre Edouard

AU - Habib, Gilbert

AU - Raoult, Didier

AU - Thuny, Franck

AU - Delahaye, Francois

AU - Delahaye, Armelle

AU - Vandenesch, Francois

AU - Donal, Erwan

AU - Donnio, Pierre Yves

AU - Flecher, Erwan

AU - Michelet, Christian

AU - Revest, Matthieu

AU - Tattevin, Pierre

AU - Chevalier, Florent

AU - Jeu, Antoine

AU - Rémadi, Jean Paul

AU - Rusinaru, Dan

AU - Tribouilloy, Christophe

AU - Bernard, Yvette

AU - Chirouze, Catherine

AU - Hoen, Bruno

AU - Leroy, Joel

AU - Plesiat, Patrick

AU - Naber, Christoph

AU - Neuerburg, Carl

AU - Mazaheri, Bahram

AU - Sophia Athanasia, Carl Neuerburg

AU - Deliolanis, Ioannis

AU - Giamarellou, Helen

AU - Thomas, Tsaganos

AU - Mylona, Elena

AU - Paniara, Olga

AU - Papanicolaou, Konstantinos

AU - Pyros, John

AU - Skoutelis, Athanasios

AU - Papanikolaou, Konstantinos

AU - Sharma, Gautam

AU - Francis, Johnson

AU - Nair, Lathi

AU - Thomas, Vinod

AU - Venugopal, Krishnan

AU - Hannan, Margaret M.

AU - Hurley, John P.

AU - Wanounou, Maor

AU - Gilon, Dan

AU - Israel, Sarah

AU - Korem, Maya

AU - Strahilevitz, Jacob

AU - Durante-Mangoni, Emanuele

AU - Iossa, Domenico

AU - Orlando, Serena

AU - Ursi, Maria Paola

AU - Pafundi, Pia Clara

AU - D'Amico, Fabiana

AU - Bernardo, Mariano

AU - Cuccurullo, Susanna

AU - Dialetto, Giovanni

AU - Covino, Franco Enrico

AU - Manduca, Sabrina

AU - Della Corte, Alessandro

AU - De Feo, Marisa

AU - Tripodi, Marie Françoise

AU - Cecchi, Enrico

AU - De Rosa, Francesco

AU - Forno, Davide

AU - Imazio, Massimo

AU - Trinchero, Rita

AU - Grossi, Paolo

AU - Lattanzio, Mariangela

AU - Toniolo, Antonio

AU - Goglio, Antonio

AU - Raglio, Annibale

AU - Ravasio, Veronica

AU - Rizzi, Marco

AU - Suter, Fredy

AU - Magri, Silvia

AU - Signorini, Liana

AU - Kanafani, Zeina

AU - Kanj, Souha S.

AU - Sharif-Yakan, Ahmad

AU - Abidin, Imran

AU - Tamin, Syahidah Syed

AU - Martínez, Eduardo Rivera

AU - Soto Nieto, Gabriel Israel

AU - van der Meer, Jan T.M.

AU - Chambers, Stephen

AU - Holland, David

AU - Morris, Arthur

AU - Raymond, Nigel

AU - Read, Kerry

AU - Murdoch, David R.

AU - Dragulescu, Stefan

AU - Ionac, Adina

AU - Mornos, Cristian

AU - Butkevich, O. M.

AU - Chipigina, Natalia

AU - Kirill, Ozerecky

AU - Vadim, Kulichenko

AU - Vinogradova, Tatiana

AU - Edathodu, Jameela

AU - Halim, Magid

AU - Liew, Yee Yun

AU - Lejko-Zupanc, Tatjana

AU - Logar, Mateja

AU - Mueller-Premru, Manica

AU - Commerford, Patrick

AU - Commerford, Anita

AU - Deetlefs, Eduan

AU - Hansa, Cass

AU - Ntsekhe, Mpiko

AU - Almela, Manel

AU - Azqueta, Manuel

AU - Brunet, Merce

AU - Castro, Pedro

AU - Falces, Carlos

AU - Fuster, David

AU - Fita, Guillermina

AU - Garcia- de- la- Maria, Cristina

AU - Garcia-Gonzalez, Javier

AU - Gatell, Jose M.

AU - Marco, Francesc

AU - Miró, José M.

AU - Ortiz, José

AU - Ninot, Salvador

AU - Paré, J. Carlos

AU - Pericas, Juan M.

AU - Quintana, Eduard

AU - Ramirez, Jose

AU - Rovira, Irene

AU - Sandoval, Elena

AU - Sitges, Marta

AU - Tellez, Adrian

AU - Tolosana, José M.

AU - Vidal, Barbara

AU - Vila, Jordi

AU - Anguera, Ignasi

AU - Font, Bernat

AU - Guma, Joan Raimon

AU - Bermejo, Javier

AU - Bouza, Emilio

AU - Garcia Fernández, Miguel Angel

AU - Gonzalez-Ramallo, Victor

AU - Marín, Mercedes

AU - Muñoz, Patricia

AU - Pedromingo, Miguel

AU - Roda, Jorge

AU - Rodríguez-Créixems, Marta

AU - Solis, Jorge

AU - Fernandez-Hidalgo, Nuria

PY - 2021/4/6

Y1 - 2021/4/6

N2 - Background: Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). Objectives: This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients. Methods: Prospective cohort study (International Collaboration on Endocarditis databases, encompassing 7,715 IE episodes from 2000 to 2006 and from 2008 to 2012). Descriptive analysis of baseline characteristics, epidemiological and etiological features, complications and outcomes, and their comparison between HD and non-HD patients was performed. Risk factors for major embolic events, cardiac surgery, relapses, and in-hospital and 6-month mortality were investigated in HD-patients using multivariable logistic regression. Results: A total of 6,691 patients were included and 553 (8.3%) received HD. North America had a higher HD-IE proportion than the other regions. The predominant microorganism was Staphylococcus aureus (47.8%), followed by enterococci (15.4%). Both in-hospital and 6-month mortality were significantly higher in HD versus non–HD-IE patients (30.4% vs. 17% and 39.8% vs. 20.7%, respectively; p < 0.001). Cardiac surgery was less frequently performed among HD patients (30.6% vs. 46.2%; p < 0.001), whereas relapses were higher (9.4% vs. 2.7%; p < 0.001). Risk factors for 6-month mortality included Charlson score (hazard ratio [HR]: 1.26; 95% confidence interval [CI]: 1.11 to 1.44; p = 0.001), CNS emboli and other emboli (HR: 3.11; 95% CI: 1.84 to 5.27; p < 0.001; and HR: 1.73; 95% CI: 1.02 to 2.93; p = 0.04, respectively), persistent bacteremia (HR: 1.79; 95% CI: 1.11 to 2.88; p = 0.02), and acute onset heart failure (HR: 2.37; 95% CI: 1.49 to 3.78; p < 0.001). Conclusions: HD-IE is a health care–associated infection chiefly caused by S. aureus, with increasing rates of enterococcal IE. Mortality and relapses are very high and significantly larger than in non–HD-IE patients, whereas cardiac surgery is less frequently performed.

AB - Background: Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). Objectives: This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients. Methods: Prospective cohort study (International Collaboration on Endocarditis databases, encompassing 7,715 IE episodes from 2000 to 2006 and from 2008 to 2012). Descriptive analysis of baseline characteristics, epidemiological and etiological features, complications and outcomes, and their comparison between HD and non-HD patients was performed. Risk factors for major embolic events, cardiac surgery, relapses, and in-hospital and 6-month mortality were investigated in HD-patients using multivariable logistic regression. Results: A total of 6,691 patients were included and 553 (8.3%) received HD. North America had a higher HD-IE proportion than the other regions. The predominant microorganism was Staphylococcus aureus (47.8%), followed by enterococci (15.4%). Both in-hospital and 6-month mortality were significantly higher in HD versus non–HD-IE patients (30.4% vs. 17% and 39.8% vs. 20.7%, respectively; p < 0.001). Cardiac surgery was less frequently performed among HD patients (30.6% vs. 46.2%; p < 0.001), whereas relapses were higher (9.4% vs. 2.7%; p < 0.001). Risk factors for 6-month mortality included Charlson score (hazard ratio [HR]: 1.26; 95% confidence interval [CI]: 1.11 to 1.44; p = 0.001), CNS emboli and other emboli (HR: 3.11; 95% CI: 1.84 to 5.27; p < 0.001; and HR: 1.73; 95% CI: 1.02 to 2.93; p = 0.04, respectively), persistent bacteremia (HR: 1.79; 95% CI: 1.11 to 2.88; p = 0.02), and acute onset heart failure (HR: 2.37; 95% CI: 1.49 to 3.78; p < 0.001). Conclusions: HD-IE is a health care–associated infection chiefly caused by S. aureus, with increasing rates of enterococcal IE. Mortality and relapses are very high and significantly larger than in non–HD-IE patients, whereas cardiac surgery is less frequently performed.

KW - cardiac surgery

KW - enterococci

KW - hemodialysis

KW - infective endocarditis

KW - relapses

KW - Staphylococcus aureus

UR - http://www.scopus.com/inward/record.url?scp=85103063920&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2021.02.014

DO - 10.1016/j.jacc.2021.02.014

M3 - Article

C2 - 33795037

AN - SCOPUS:85103063920

SN - 0735-1097

VL - 77

SP - 1629

EP - 1640

JO - Journal of The American College of Cardiology

JF - Journal of The American College of Cardiology

IS - 13

ER -

Infective Endocarditis in Patients on Chronic Hemodialysis

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