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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifteen male hemodialysis patients developed 21 episodes of S. aureus bacteremia. Infections involving vascular access were responsible for 65% of initial bacteremias. The arteriovenous fistula was the most prevalent type of access used, and thus was responsible for the majority of these illnesses. Phage typing indicated that recurrent episodes were due to reinfection rather than relapse. Complications included endocarditis, osteomyelitis, septic embolism, and pericarditis. One patient died of infectious complications. It is recommended that hemodialysis patients developing bacteremia due to S. aureus receive at least 6 weeks of beta lactamase-resistant antimicrobial therapy.
J Dial 1977
PMID:Staphylococcus aureus bacteremia in hemodialysis patients. 60 60

The presence of systemic disease may further increase the risk of bacterial endocarditis in the patient on chronic hemodialysis. Three patients are described; one with primary amyloidosis, a second with insulin dependent diabetes mellitus, and a third with heroin nephropathy who developed S.B.E. While the presence of the uremic state may hinder the recognition of endocarditis, the development of transient neurologic deficits, recent access infections and recurrent bacteremic episodes should be looked for as early clues to the diagnosis in this patient population.
J Dial 1978
PMID:Endocarditis in hemodialysis patients with systemic disease. 64 Dec 46

The frequency of mesangial IgA deposition was examined in 250 consecutive autopsy cases without known renal disease. Diffuse granular mesangial deposits of IgA were detected in 12 of 250 cases (4.8%). In six patients IgA deposits were associated with liver cirrhosis. Six patients (2.4%) suffered from various other conditions including endocarditis, bronchial asthma, cardiovascular disease, and neoplasia. Two of these patients had completely negative urine analysis on repeated investigations, whereas three patients exhibited microscopic haematuria and/or mild proteinuria. IgA1 was the major constituent in all specimens. C3c deposits in glomeruli were detected in one kidney. Our findings indicate that clinically overt renal disease is present in only a limited proportion of individuals with mesangial IgA deposits. Apparently, it represents the tip of an iceberg.
Nephrol Dial Transplant 1989
PMID:Frequency of mesangial IgA deposits in a non-selected autopsy series. 251 84

A 42-year-old female patient on hemodialysis (HD) developed S. aureus endocarditis of her aortic and mitral valves following the unsuccessful antibiotic treatment of an infected vascular access. She required aortic valve replacement and repair of her mitral valve. She had been receiving HD 2-3 times per week using a standard dialysate bath. Three and one-half weeks postoperatively she developed hypercalcemia with the following peak values: total calcium (t-Ca), 13.7 mg/dL; ionized calcium (i-Ca), 1.76 mmol/L. Hemodynamic instability necessitated switching from HD to peritoneal dialysis (PD). Following 48 hours of unsuccessful treatment of hypercalcemia using Baxter 2.5 mEq/L Dianeal, zero calcium dialysate prepared by our in-hospital pharmacy was used for cycler PD. Four days later the t-Ca was 10.6 mg/dL, and i-Ca was 1.32 mmol/L. Thereafter, 2.5 mEq/L calcium Dianeal was resumed. When hypercalcemia recurred (t-Ca 12.0 mg/dL and i-Ca 1.76 mmol/L), repeat use of zero calcium dialysate returned the patient's calcium values to within normal limits (t-Ca 9.0 mg/dL, i-Ca 1.20 mmol/L) by 7 days posttreatment. The results in this patient demonstrate that in-hospital pharmacies can conveniently prepare prescription-ordered dialysate and that zero calcium dialysate is yet an additional modality available to correct hypercalcemia in PD patients.
Adv Perit Dial 1993
PMID:Successful use of zero calcium dialysate to treat hypercalcemia in a postsurgical peritoneal dialysis patient. 810 44

Haemodialysis access graft infection is easily recognizable when local symptoms (warmth, swelling, pain, or drainage) predominate, and endocarditis is a well established complication of infected grafts. We report a case of bacterial endocarditis complicating silent infection in clotted haemodialysis access graft. It is suggested that, clotted non-functioning grafts may be the harbingers of silent infection, and should be suspected as the source of infection in every haemodialysis patient that presents with fever, even in the absence of clinical signs of graft site infection.
Nephrol Dial Transplant 1998 Sep
PMID:The patient with a clotted PTFE graft developing fever. 976 34

Tunneled dialysis catheters (TDC) are extensively used for long-term venous hemodialysis access and their use is frequently associated with infectious complications. Catheter-related bacteremia (CRB) is the most common and important infection associated with TDC use and may be caused by a wide variety of Gram-positive or Gram-negative organisms. Prevention of CRB can be difficult despite use of rigorous infection-control techniques for catheter insertion and access. A number of antibacterial catheter-packing solutions hold promise for reduction of CRB. Treatment of CRB with antibiotics alone yields poor results and may increase the risk for other infectious complications, especially endocarditis. In selected cases where initial infection control can be achieved with antibiotics, guidewire exchange of the TDC results in cure rates equivalent to those of TDC removal and subsequent replacement. Dialysis programs should monitor TDC infections with attention to incidence, bacteriology, and outcomes.
Semin Dial
PMID:Central venous dialysis catheters: catheter-associated infection. 1185 31

Endocarditis associated with vascular access catheters for hemodialysis (HD) is a catastrophic but not widely appreciated phenomenon. Its current incidence, clinical outcome, and associated costs are not easily ascertained. Increasing use of tunneled catheters for HD access may result in a larger pool of patients at risk for endocarditis. We present two representative cases, review recent trends, and assess the current potential for additional cases.
Semin Dial
PMID:Hemodialysis catheter-associated endocarditis: clinical features, risks, and costs. 1275 89

A patient with newly diagnosed end-stage renal disease (ESRD) received a femoral catheter for hemodialysis (HD). Shortly thereafter he developed fever, and blood cultures grew methicillin-resistant Staphylococcus aureus. The catheter was removed and the patient was treated with both vancomycin and rifampin; however, blood culture positivity persisted. The cerebrospinal fluid showed sterile meningitis. Subsequent imaging studies demonstrated aortic valve endocarditis and multiple mycotic aneurysms that appeared to include the intra- and extracranial vessels. The patient eventually died from sepsis. This case illustrates the aggressive and invasive nature of systemic infection with S. aureus and underscores the high morbidity and mortality associated with infections related to HD catheters.
Semin Dial
PMID:Mycotic aneurysms and death in a hemodialysis patient. 1607 60

Myocardial abscess formation is a life-threatening complication that is frequently but not exclusively associated with infective endocarditis. To our knowledge there are only two case reports of myocardial abscess formation in hemodialysis patients. Only one of these reports describes a myocardial abscess of bacterial etiology secondary to an infected intravascular hemodialysis catheter. Furthermore, there are no reports of bacterial myocardial abscess occurring in a hemodialysis patient with an infected arteriovenous fistula. Myocardial abscess can manifest in a variety of clinical scenarios ranging from an asymptomatic state to a catastrophic myocardial wall rupture. In the case described, the myocardial abscess lead to a rapidly progressive course consisting of recurrent cardiac arrhythmias that were ultimately fatal. Our case involved the formation of a myocardial abscess in the presence of a methicillin-resistant Staphylococcus aureus bacteremia without any evidence of infective endocarditis. We report this case to call attention to the possibility of bacterial myocardial abscess occurring with infection of an arteriovenous fistula in a hemodialysis patient, which can manifest as recurrent severe cardiac arrhythmias refractory to medical therapy.
Semin Dial
PMID:Myocardial abscess and fatal cardiac arrhythmia in a hemodialysis patient with an arterio-venous fistula infection. 1789 52

Dialysis catheter-related bacteremia (CRB) can frequently be treated with systemic antibiotics, in conjunction with an antibiotic lock, in an attempt to salvage the catheter. It is unknown whether CRB associated with an exit-site infection can be treated with such an approach. We retrospectively queried a prospective, computerized vascular access database, and identified 1436 episodes of CRB, of which 64 cases had a concurrent exit site. The frequency of concurrent exit-site infection was 9.6% with Staphylococcus epidermidis, 6.1% with Staphylococcus aureus, and only 0.7% with Gram negative CRB (p < 0.001 for Staphylococcus vs. Gram negative rods). Five serious complications (four major sepses and one endocarditis) occurred in 24 patients with S. aureus infection, but none in 32 episodes of S. epidermidis infection (p = 0.01). Catheter survival was significantly shorter in patients with S. aureus infections. The median catheter survival (without infection or dysfunction) was 14 days with S. aureus vs. 30 days with S. epidermidis infection (p = 0.035). In conclusion, concurrent exit-site infection is seen most commonly in association with Staphylococcal CRB. When the infecting organism is S. epidermidis, attempted salvage with systemic antibiotics and an antibiotic lock is reasonable. However, prompt catheter removal is indicated when the pathogen is S. aureus.
Semin Dial
PMID:Clinical management of dialysis catheter-related bacteremia with concurrent exit-site infection. 2151 93


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