Robinson D L, Fowler V G, Sexton D J, Corey R G, Conlon P J
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Am J Kidney Dis. 1997 Oct;30(4):521-4. doi: 10.1016/s0272-6386(97)90311-5.
Infective endocarditis (IE) is one of the most serious complications of bacteremia. Hemodialysis patients with prosthetic vascular access devices such as dual-lumen cuffed venous catheters and polytetrafluoroethylene (PTFE) grafts are at increased risk for bacteremia compared with patients with primary arteriovenous fistulae (PAVF). We present 20 cases of IE in hemodialysis patients seen at our institution over a 7-year period. Eight patients had PTFE grafts, 11 had dual-lumen cuffed catheters, and one had a PAVF. All patients underwent transthoracic echocardiography (TTE) and 16 patients also received transesophageal echocardiography (TEE). The Duke Criteria were used to characterize patients as definite or possible IE. Organisms were Staphylococcus aureus (55%), Staphylococcus epidermidis (25%), and Enterococcus sp (10%). The mitral valve (50%) was the most commonly affected valve, followed by aortic (30%) and right-sided IE (25%). Valve replacement was performed in five patients, of whom three survived hospitalization. The overall mortality rate for the series was 30%. All the dual-lumen cuffed catheters were removed, while only two of the eight PTFE grafts were removed. Four of the six patients who died had PTFE grafts, of which one was judged to be infected and removed. Echocardiography was essential to the diagnosis of IE. Vegetations were found in 50% by TTE and 81% by TEE. Six patients with no vegetations on TTE were found to have vegetations on TEE.
感染性心内膜炎（IE）是菌血症最严重的并发症之一。与原发性动静脉内瘘（PAVF）患者相比，使用双腔带 cuff 静脉导管和聚四氟乙烯（PTFE）移植物等人工血管通路装置的血液透析患者发生菌血症的风险更高。我们报告了本机构在 7 年期间诊治的 20 例血液透析患者的 IE 病例。8 例患者使用了 PTFE 移植物，11 例使用了双腔带 cuff 导管，1 例使用了 PAVF。所有患者均接受了经胸超声心动图（TTE）检查，16 例患者还接受了经食管超声心动图（TEE）检查。采用 Duke 标准将患者分为确诊或可能的 IE。病原菌为金黄色葡萄球菌（55%）、表皮葡萄球菌（25%）和肠球菌属（10%）。二尖瓣（50%）是最常受累的瓣膜，其次是主动脉瓣（30%）和右侧 IE（25%）。5 例患者进行了瓣膜置换，其中 3 例存活出院。该系列患者的总死亡率为 30%。所有双腔带 cuff 导管均被移除，而 8 例 PTFE 移植物中仅 2 例被移除。死亡的 6 例患者中有 4 例使用了 PTFE 移植物，其中 1 例被判定感染并被移除。超声心动图对 IE 的诊断至关重要。TTE 发现 50%的患者有赘生物，TEE 发现 81%的患者有赘生物。6 例 TTE 未发现赘生物的患者在 TEE 检查中发现有赘生物。
