Infective Endocarditis in Patients on Chronic Hemodialysis

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:77

Article

Pericas, Juan M.¹  Llopis, Jaume²  Jesus Jimenez-Exposito, Maria¹  Kourany, Wissam M.³  Almirante, Benito⁴  Carosi, Giampiero⁵  Durante-Mangoni, Emanuele⁶  Fortes, Claudio Querido⁷  Giannitsioti, Efthymia⁸  Lerakis, Stamatios⁹  Montagna-Mella, Rodrigo¹⁰  Ambrosioni, Juan¹  Tan, Ru-San¹¹  Mestres, Carlos A.¹²  Wray, Dannah¹³  Pachirat, Orathai¹⁴  Moreno, Asuncion¹  Chu, Vivian H.³  de Lazzari, Elisa¹  Fowler, Vance G.³  Miro, Jose M.¹ 

[1] Univ Barcelona, August Pi I Sunyer Biomed Res Inst, Infect Dis Serv, Hosp Clin, Barcelona, Spain

[2] Univ Barcelona, Dept Genet Microbiol & Stat, Barcelona, Spain

[3] Duke Univ, Sch Med, Infect Dis Div, Durham, NC USA

[4] Hosp Univ Vall dHebron, Infect Dis Serv, Barcelona, Spain

[5] Univ Brescia, Infect Dis Div, Spedali Civili, Brescia, Italy

[6] Univ Campania Luigi Vanvitelli, Monaldi Hosp, Internal Med Dept, Naples, Italy

[7] Univ Fed Rio de Janeiro, Hosp Univ Clementino Fraga Filho, Infect Dis Dept, Rio De Janeiro, Brazil

[8] Attikon Univ Gen Hosp, Internal Med Dept, Athens, Greece

[9] Mt Sinai Hlth Syst, Dept Cardiol, New York, NY USA

[10] Hosp Clin Univ Chile, Dept Cardiol, Santiago, Chile

[11] Natl Heart Ctr, Dept Cardiol, Singapore, Singapore

[12] Univ Hosp Zurich, Dept Cardiovasc Surg, Zurich, Switzerland

[13] Med Univ South Carolina, Internal Med Dept, Charleston, SC 29425 USA

[14] Khon Kaen Univ, Dept Med, Div Cardiol, Khon Kaen, Thailand

关键词: cardiac surgery;    enterococci;    hemodialysis;    infective endocarditis;    relapses;    Staphylococcus aureus;   

DOI  :  10.1016/j.jacc.2021.02.014

来源: Elsevier

【 摘 要 】

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. (C) 2021 by the American College of Cardiology Foundation.

【 授权许可】

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