# Endocarditis on Hemodialysis: Link Bloodstream and Access

Monitor cultures, clinical response, drug-related adverse effects, and access planning. Treatment success requires resolution of the infection pathway.

![Infographic: Endocarditis on Hemodialysis: Link Bloodstream and Access](https://urinenephrology.org/visual-reference/images/mastery-hd-endocarditis.png?v=20261003c)

## High exposure, high stakes

Repeated vascular access and bloodstream infection risk make endocarditis an important consideration in dialysis patients with persistent bacteremia or systemic illness.

## Look for more than fever

Embolic signs, new cardiac findings, access abnormalities, persistent positive cultures, and unexplained deterioration can reveal a deeper infection.

## Define the organism and source

Blood cultures, appropriate echocardiography, access assessment, and susceptibility testing guide diagnosis and treatment. Prior antibiotics can complicate interpretation.

## Coordinate treatment

Coordinate infectious disease, nephrology, cardiology, and surgery. Choose susceptibility-directed treatment and dialysis-adjusted exposure; intermittent dialysis-day-only regimens are not established replacements for standard therapy.

## Do not ignore source control

An infected catheter, persistent bacteremia, valve complications, or metastatic infection may prevent cure despite an apparently appropriate antibiotic.

## Follow for relapse and harm

Monitor cultures, clinical response, drug-related adverse effects, and access planning. Treatment success requires resolution of the infection pathway.

## Supporting evidence

- [2023 ESC Guidelines for the management of endocarditis.](https://pubmed.ncbi.nlm.nih.gov/37622656/)
- [Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating enterococcus faecalis infective endocarditis.](https://pubmed.ncbi.nlm.nih.gov/23392394/)
- [KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update.](https://pubmed.ncbi.nlm.nih.gov/32778223/)
- [Use of pharmacokinetic and pharmacodynamic principles to determine optimal administration of daptomycin in patients receiving standardized thrice-weekly hemodialysis.](https://pubmed.ncbi.nlm.nih.gov/21282429/)

## Source lessons

- [enterococcal endocarditis hemodialysis](https://urinenephrology.org/mastery/dialysis-advanced/enterococcal-endocarditis-hemodialysis.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.