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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Kidney+Dis
2014 ; 64
(1
): 104-10
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Clinical presentation and outcomes of cardiovascular implantable electronic
device infections in hemodialysis patients
#MMPMID24388672
Hickson LJ
; Gooden JY
; Le KY
; Baddour LM
; Friedman PA
; Hayes DL
; Wilson WR
; Steckelberg JM
; Sohail MR
Am J Kidney Dis
2014[Jul]; 64
(1
): 104-10
PMID24388672
show ga
BACKGROUND: Infection is a serious complication of cardiovascular implantable
electronic device (CIED) implantation. Kidney failure is as an independent risk
factor for CIED infection and associated mortality. The presence of multiple
comorbid conditions may contribute to varied clinical presentations and poor
outcomes in hemodialysis (HD)-dependent patients with cardiac device infection.
STUDY DESIGN: Case series. SETTING & PARTICIPANTS: CIED infections in HD patients
(n=17) and non-HD patients (n=398) at Mayo Clinic in Rochester, MN, between 1991
and 2008. OUTCOMES: Surgical management and death. MEASUREMENTS: Clinical
presentations, microbial organisms. RESULTS: Of 415 patients admitted with CIED
infection, 17 (4%) were receiving maintenance HD therapy. Among those on HD
therapy, mean age was 72±15 (SD) years, 59% were women, and 53% had a central
venous catheter for dialysis access. All 17 patients receiving HD therapy
presented with CIED-associated bloodstream infection and 41% of these had
infected vegetations on CIED leads or cardiac valves. A majority (82%) were
managed with complete device removal and almost half (43%) received a replacement
device when bloodstream infection cleared. Device infection was associated with
significant short-term mortality in HD patients and 90-day survival was only 76%
in this group of patients. LIMITATIONS: Smaller sample size, majority white
cohort, observational study. CONCLUSIONS: CIED infection in patients receiving HD
usually is associated with bloodstream infection and frequently is complicated
with device-related endocarditis. Despite complete device removal in the majority
of HD patients with infection, mortality remains high.