Infective Endocarditis in Patients on Chronic Hemodialysis.

Autor:	Pericàs JM; Infectious Diseases Service, Hospital Clínic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain., Llopis J; Department of Genetics, Microbiology and Statistics, University de Barcelona, Barcelona, Spain., Jiménez-Exposito MJ; Infectious Diseases Service, Hospital Clínic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain., Kourany WM; Duke University School of Medicine, Durham, North Carolina., Almirante B; Infectious Diseases Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Carosi G; Spedali Civili, University of Brescia, Brescia, Italy., Durante-Mangoni E; Monaldi Hospital, University of Campania Luigi Vanvitelli, Naples, Italy., Fortes CQ; Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Giannitsioti E; Attikon University General Hospital, Athens, Greece., Lerakis S; Mount Sinai Health System, New York, New York, USA., Montagna-Mella R; Hospital Clínico Universidad de Chile, Santiago, Chile., Ambrosioni J; Infectious Diseases Service, Hospital Clínic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain., Tan RS; National Heart Centre, Singapore., Mestres CA; Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland., Wray D; Medical University of South Carolina, Charleston, South Carolina, USA., Pachirat O; Khon Kaen University, Khon Kaen, Thailand., Moreno A; Infectious Diseases Service, Hospital Clínic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain., Chu VH; Duke University School of Medicine, Durham, North Carolina., de Lazzari E; Infectious Diseases Service, Hospital Clínic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain., Fowler VG Jr; Duke University School of Medicine, Durham, North Carolina., Miró JM; Infectious Diseases Service, Hospital Clínic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain. Electronic address: jmmiro@ub.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2021 Apr 06; Vol. 77 (13), pp. 1629-1640.
DOI:	10.1016/j.jacc.2021.02.014
Abstrakt:	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. Competing Interests: Funding Support and Author Disclosures This study was supported by the National Institutes of Health (AI-059111 [to Dr. Fowler], Red Española de Investigación en Patología Infecciosa (V–2003-REDC14A-O [to Dr. Miró], and Instituto de Salud Carlos III (FIS 00-0475 [to Dr. Miró]). Dr. Miró received a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain, during 2017 to 2019. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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