**Author details**

*8. Suspicion of IE in HD patients? Always use TEE*

*9. Vancomycin not as prophylactic*

138 Contemporary Challenges in Endocarditis

different from MRSA.

**9. Conclusion**

answers.

in primary health care service.

to offer optimal service quality.

Unavailability of the adequate equipment.

and definitive treatment with kidney transplant.

information about their diseases or their HD route.

TTE if not conclusive TEE to rule out or confirm the diagnosis; if TTE conclusive, use TEE to

Confirm IE in HD patients; do not use prophylactic vancomycin if you suspect any pathogen

Biological prosthesis is a good option for these patients; the heart team must individualize each case; and consider the benefits or disadvantages of mechanical or biological prosthesis.

Here we have addressed the different protocols and outcomes among developed countries due to ESRD patients' population, economy and health care differences in each country. This means that the recommendations of different associations and foundations have not been completely

So to answer the question: what is the problem in developing countries? There are many

Late ESRD diagnosis or any risk factors can end in ESRD, due to not having a routine checkup

Incomplete protocols, as already stated, are common in developing countries, making changes to these protocols based on "saving" money only or to provide more medical care to a large number of patients, giving them suboptimal care due to inadequate time for each patient. Because health care providers in developing countries have too many patients, it is not possible

Not having the right timing between dialysis treatments, and especially between diagnosis

In developing countries, most of the patients are uneducated, or they do not have accurate

In the recommendations given in this chapter, after analyzing the literature and the guidelines for preventing IE in ESRD patients, we summarized the prevention strategies and sought to apply them in any developing country for having less incidence of IE in ESRD patients.

Long waiting lists due to fewer transplant centers for kidney transplantation.

rule out other cardiac lesions or unidentified vegetations in other valves.

*10. Mechanical prosthesis not the only option for IE in HD patients*

followed up by all HD systems even in developed countries.

Díaz-García Héctor Rafael1\*, Contreras-de la Torre Nancy Anabel1 , Alemán-Villalobos Alfonso1 , Carrillo-Galindo María de Jesús1 , Gómez-Jiménez Olivia Berenice1 , Esparza-Beléndez Edgar1 , Ramírez-Rosales Gladys Eloísa2 , Portilla-d Buen Eliseo3 and Arreola-Torres Ramón1,2,3

\*Address all correspondence to: heradiga@hotmail.com

1 Cardiac Surgery Service, Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social, Mexico

2 Immunology Laboratory, University Center of Health Sciences, Universidad de Guadalajara, Mexico

3 Surgical Research Division, Biomedical Research Center, Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social, Mexico
