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The incidence of Infective Endocarditis (IE) is higher in dialysis patients compared to the general population. A major risk factor for IE in this group stems from bacterial invasion during repeated vascular access. Previous studies have shown increased risk of bacteremia in patients with indwelling dialysis catheters compared to permanent vascular access. However, association between the development of IE and the type of dialysis access is unclear. We aimed to examine the associated types of intravascular access and route of infection in dialysis patients who were admitted with IE at our center. All patients admitted to Albert Einstein Medical Center in Philadelphia with a diagnosis of IE who were on chronic hemodialysis were identified from the hospital database for the period of 1/1/07 to 12/31/18. Modified Duke criteria were used to confirm the diagnosis of IE. A total of 96 cases were identified. Of those, 57 patients had an indwelling dialysis catheter while the other 39 had permanent dialysis access. In 82% of patients with dialysis catheters, their dialysis access site was identified as the primary source of infection compared to 30% in those with permanent dialysis access (p<0.001). The number of dialysis catheters placed in the preceding 6 months was strongly associated with endocarditis resulting from the dialysis access site (OR=3.202, p=0.025). Dialysis catheters are more likely to serve as the source of infection in dialysis patients developing IE compared to permanent dialysis access. Increased awareness of risk of IE associated with dialysis catheters is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Infective endocarditis (IE) poses a great challenge to the field of cardiology due to high mortality, approaching 30% at 1-year, despite optimal care. Hypothesis: We studied causative organisms, in-hospital mortality and predictors of 30-day hospital readmission after a diagnosis of IE. Methods: Nationwide Readmissions Database was utilized to identify patients with a primary discharge diagnosis of IE using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9, CM), procedural code 421.0. Primary outcome was 30-day readmission. Hierarchical multivariable logistic regression was used to adjust for confounders. Results: Over 6 years (2010-2015), 187,438 patients were admitted with a primary diagnosis of IE. Twenty four percent were readmitted within 30 days. Staphylococcus aureus (27%), streptococcus viridians (22%), gram negative species (6%) and fungal species (0.24%) were identified as causative organisms. Predictors of increased readmissions were female sex (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.02 to 1.1, p<0.001), staphylococcus aureus infection (OR 1.06, 95% CI 1.02 to 1.1, p <0.001), diabetes (OR 1.11, 95%CI 1.07 to 1.63, p<0.001), chronic lung disease (OR 1.16, 95%ci 1.11 TO 1.2, P<0.001), chronic liver disease (or 1.06, 95%CI 1.1 to 1.23, p<0.001), acute kidney injury (OR 1.32, 95%CI 1.26 to 1.37, p<0.001), acute heart failure (OR 1.17, 95%CI 1.12 to 1.22, p<0.001) and anemia (OR 1.09, 95%CI 1.06 to 1.13, p<0.01). In-hospital mortality was 13% and average length of stay (LOS) was 12 days. Thirty-six percent patients were discharged to a facility. Conclusions: We identified high in-hospital mortality and 30-day readmission rates for IE patients between 2010 and 2015. Females, staphylococcus aureus infection, anemia, acute heart failure, chronic lung disease, chronic liver disease, acute kidney injury and diabetes were independently associated with increased 30-day readmissions in IE patients. [ABSTRACT FROM AUTHOR]

Introduction: Infective endocarditis (IE) is a frequent cause of morbidity and mortality in patients with intracardiac devices, prosthetic valves and unrepaired congenital anomalies. Hypothesis: We aim to look for comorbidities, etiologies and trends of 30-day hospital readmission after the diagnosis of IE. Methods: Nationwide Readmissions Database (2010-2015) was utilized to identify patients with primary discharge diagnosis of IE using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9, CM), procedural code 421.0. Primary outcome was 30-day readmission. Etiologies were identified using ICD-9 codes in primary diagnosis field. Results: Among 187,438 patients admitted with the primary diagnosis of IE, 44,151 patients (24%) were readmitted within 30 days (60% Male, average age 60 years). Most prevalent comorbidities included hypertension (56%), anemia (41%), chronic kidney disease (31%), diabetes (30%), valvular heart disease (22%), heart failure (21%) and intravenous drug abuse (15%). Most common etiologies included sepsis (14%), acute heart failure (HF) (8%), acute kidney injury (6%), intracardiac device infection (5.6%) and recurrence of IE (2.7%). Neurological complications and mechanical valvular dysfunction accounted for 2.7% and 1.6% of total 30-day readmissions. Half of the readmissions (51%) happened in first 11 days of discharge. Among the readmitted patients, 86% had 1 readmission, 13% had 2 readmissions and 1.5% of patients had 3 readmissions in 30 days after discharge. Conclusions: We identified sepsis, acute HF, acute kidney injury and intracardiac device infection as the most common etiologies of readmission. Identifying high risk patients during index admission can help reduce the high readmission rate. Prospective trials are warranted to identify these high-risk patients. [ABSTRACT FROM AUTHOR]