Author/Authors :
Montasser, Dina Agadir Hemodialysis Center, First Medical Center, Morocco , Bahadi, Abdelali Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Zajjari, Yassir Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Asserraji, Mohamed Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Alayoude, Ahmed Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Moujoud, Omar Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Aattif, Toufik Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Kadiri, Moncef Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Zemraoui, Nadir Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , El Kabbaj, Driss Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Hassani, Mohamed Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Benyahia, Mohamed Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , El Allam, Mustapha Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Oualim, Zouhir Military Hospital Mohammed V - Department of Nephrology, Dialysis and Renal Transplantation, Morocco , Akhmouch, Ismail Agadir Hemodialysis Center, First Medical Center, Morocco
Abstract :
Since the 1960s,regular hemodialysis (HD) was recognized as a risk factor for the development of infective endocarditis (IE),particularly at vascular access sites. The present report describes our experience at the Etat Major General Agadir,Morocco,of taking care of IE in patients on regular dialysis. A retrospective analysis was made of five cases of IE in patients receiving regular HD having arteriovenous fistula as vascular access. They were sent from four private centers and admitted in our formation between January 2004 and March 2009. Infective endocarditis was detected after 34.5 months following initiation of dialysis. The causative organisms included Staphylococcus and Enterococcus in two cases each and negative blood culture in one case. A recent history of infection ( 3 months) of the vascular access was found in three cases. Peripheric embolic phenomena were noted in two cases. A pre-existing heart disease was common and contributed to heart failure. Mortality was frequent due to valvular perforations and congestive heart failure,making the medical treatment alone unsatisfactory. Two patients survived and three of our patients received a prosthetic valve replacement,with a median survival after surgery of 10.3 months/person. The clinical diagnosis of infective endocarditis in regularly dialyzed patients remains difficult,with the presence of vascular calcification as a common risk factor. The vascular catheter infections are the cardinal gateway of pathogenic organisms,which are mainly Staphylococcus. The prognosis is bad and the mortality is significant,whereas medical and surgical treatments are often established in these patients who have many factors of comorbidity.
