Nephrologists Hate the Dialysis Catheters: A Systemic Review of Dialysis Catheter Associated Infective Endocarditis

Abstract

A 53-year-old Egyptian female with end stage renal disease, one month after start of hemodialysis via an internal jugular catheter, presented with fever and shortness of breath. She developed desquamating vesiculobullous lesions, widespread on her body. She was in profound septic shock and broad spectrum antibiotics were started with appropriate fluid replenishment. An echocardiogram revealed bulky leaflets of the mitral valve with a highly mobile vegetation about 2.3 cm long attached to the anterior leaflet. CT scan of the chest, abdomen, and pelvis showed bilateral pleural effusions in the chest, with triangular opacities in the lungs suggestive of infarcts. There was splenomegaly with triangular hypodensities consistent with splenic infarcts. Blood cultures repeatedly grew Candida albicans. Despite parenteral antifungal therapy, the patient deteriorated over the course of 5 days. She died due to a subsequent cardiac arrest. Systemic review of literature revealed that the rate of infection varies amongst the various types of accesses, and it is well documented that AV fistulas have a much less rate of infection in comparison to temporary catheters. All dialysis units should strive to make a multidisciplinary effort to have a referral process early on, for access creation, and to avoid catheters associated morbidity.

Figure 1

Image depicting severe end arteriolar embolic phenomenon to the nose.

Figure 2

Image depicting desquamating vesiculobullous lesions of the feet.

Figure 3

Image depicting a transthoracic echo cardiogram, depicting vegetation and severe mitral regurgitation.

Figure 4

CT scan of the chest, depicting wedge shaped large pulmonary infarct.

Figure 5

CT scan of the abdomen, depicting splenic infarct.

Figure 6

Depicting vascular access infection rate by type of vascular access.

Figure 7

Pathophysiology of impeded immune function in renal failure.