Abstract
Background: Infective endocarditis (IE) is a serious and life-threatening infection that carries high morbidity and mortality, particularly among patients undergoing hemodialysis (HD). Repeated vascular access, frequent healthcare exposure, and multiple comorbidities increase the susceptibility of HD patients to bloodstream infections that may progress to IE. Although antibiotic therapy remains the cornerstone of treatment, evidence regarding treatment outcomes in this population remains scattered. This systematic review and meta-analysis aimed to evaluate the effectiveness and outcomes of antibiotic therapy for IE among HD patients.
Methods: This systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A comprehensive literature search was performed in PubMed/MEDLINE, Cochrane Library, DOAJ, and Google Scholar from database inception to the latest available date. Studies involving adult HD patients diagnosed with IE and treated with systemic antibiotic therapy were included. Observational studies, cohort studies, and case series with ≥10 patients were eligible. Data extraction was performed independently by two reviewers using a standardized form. Key outcomes included mortality, clinical cure, relapse rates, and treatment characteristics. Pooled proportions were calculated using a random-effects model, and heterogeneity was assessed using the I² statistic.
Results: Twelve studies involving 325,320 HD patients were included in the analysis. The pooled prevalence of IE among HD patients was 49% (95% CI: 23-75) with substantial heterogeneity (I² = 100%). The pooled clinical cure rate after antibiotic therapy was 59% (95% CI: 39-80) with no heterogeneity (I² = 0%, p = 0.649). The relapse rate was relatively low at 4% (95% CI: 0-11) but showed moderate heterogeneity (I² = 78.6%, p = 0.009). Despite treatment, pooled mortality remained high at 41% (95% CI: 33-50) with significant heterogeneity (I² = 85%, p < 0.001). Mortality was higher with treatment duration <6 weeks (56%) compared with ≥6 weeks (32%).
Conclusion: Antibiotic therapy plays a critical role in the management of IE among HD patients and can achieve clinical cure in a considerable proportion of cases. However, mortality remains high, emphasizing the need for optimized treatment strategies, early diagnosis, and multidisciplinary management to improve patient outcomes.

Key words: Infective Endocarditis; Hemodialysis; Antibiotic Therapy; Chronic Kidney Disease; Systematic Review and Meta-analysis