**6. IE in HD patients in western Mexico**

Our group works at a reference center, in the Mexican Institute of Social Security (IMSS for its acronym in Spanish) and takes care of all cardiothoracic surgical patients in the west of Mexico that are affiliated to IMSS. This means that more than 10 states represent more than 8.5 million affiliated people and possible patients. There are other hospitals in western Mexico that deal with endocarditis patients, but a patient who has surgical indication or who is seriously ill is sent to our center.

We retrospectively analyzed the last 5 year cases of IE in our center. There were 173 cases of which 77 (44.5%) were surgically treated. In these 77 patients, 33 (42.85%) patient where in HD. We used the IE in general population guidelines for the decision of medical or surgical treatment in all our patients.

**Figure 1.** Affected valves in HD patients (IMSS 2011–2015).

In contrast to what previous publications have described regarding IE in HD patients, the most commonly infected valve in our surgical population was the tricuspid valve (**Figure 1**). Also, having a mean age of 38.5 years ranging between 19 and 76 years, which is significantly lower than previous reports. We consider that this can be related to the long mean time of nontunneled HD catheters observed in our patients and also for not having proper safety protocols for the prevention of bacteremia in the HD facilities. This also could be caused by Mexico's overpopulation in public health services and the long-lasting waiting list for AVFs or kidney transplantation, causing good transplant candidates to end up as chronic dialysis patients and making them more susceptible to bacteremia and infections. Even though our hospital is the leading center for kidney transplantation in all Latin America, the waiting list is affected by the overpopulation commented before.
