Infective spondylodiscitis in patients on maintenance hemodialysis: a case series

Abstract

Infective spondylodiscitis is a rare disease. This case review describes the clinical course, risk factors, and outcomes of adult patients on maintenance hemodialysis who presented with infective spondylodiscitis at a single medical center in Taiwan. There were 18 cases (mean age: 64.9 ± 10.8 years) over more than 10 years. Analysis of underlying diseases indicated that 50% of patients had diabetes, 55.6% had hypertension, 55.6% had coronary artery disease, 22.2% had congestive heart failure, 22.2% had a cerebral vascular accident, 16.7% had liver cirrhosis, and 11.1% had malignancies. Sixty-one percent of patients had a degenerative spinal disease and the most common symptom was back pain (83.3%). A total of 38.9% of patients had leukocytosis, 99.4% had elevated levels of C-reactive protein, 78.6% had elevated erythrocyte sedimentation rates, and 55.6% had elevated levels of alkaline phosphatase. The average hemodialysis duration was 72.8 ± 87.5 months, and 8 patients (44.4%) started hemodialysis within 1 year prior to infective spondylodiscitis. Four patients (22.2%) had vascular access infection-associated spondylodiscitis. The lumbar region was the most common location of infection (77.8%), 44.4% of patients developed abscesses, and Staphylococci were the most common pathogen (38.9%). The mortality rate was 16.7%, all due to sepsis. Thirty-three percent of the survivors had recurrent infective spondylodiscitis within 1 year. Infective spondylodiscitis should be considered in hemodialysis patients who present with prolonged back pain with or without fever. Non-contrast MRI is an appropriate diagnostic tool for this condition. Vascular access infection increases the risk for infective spondylodiscitis in hemodialysis patients.

Identifying risk groups of infectious spondylitis in patients with end-stage renal disease under hemodialysis: a propensity score-matched case-control study

“…Both combinations have adequate predictability for IS within future 1 month. Due to the natural rarity of IS [1, 7], there was limited sample size and it may be improper for us to add in more variables in light of it. However, based on our findings, we strongly suggest physicians to maintain a high degree of suspicion for infectious process facing symptoms of back pain, neurological deficit, unexplainable fever, weight loss, lethargy, or confusion in patients receiving maintenance HD, particularly if there has been an unexpected high ALP level, or inexplicable low RDW level following a recent access intervention in patients with relatively short HD vintage.…”

“…Early identification of IS to prompt initiation of therapy is vital in ensuring successful treatment and preventing morbidity. Because of the insidious onset of IS symptoms and the fact that most of the specific changes in imaging tests require two to eight weeks after the onset of the infection, the diagnosis may be delayed and lead to serious complications including irreversible neurological deficits and death [7]. Thanks to the high sensitivities of serum markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), they could serve as screening tests prior to magnetic resonance imaging (MRI), the gold standard to diagnose and evaluate the extent of IS [1].…”

Spondylodiscitis: a common complication of brucellosis

“…Bosilkovski et al [33] showed that significantly-higher ESR was associated with osteoarticular brucellosis in univariate analysis. Another study found that a total of 78.6% of patients with infective spondylodiscitis had elevated ESR, and 55.6% had elevated levels of ALP [11].…”

“…Among osteoarticular complications, spondylodiscitis is a frequent and serious complication of brucellosis. Antibiotic treatment is mostly successful in early stages with no or minor neurological deficits; however, diagnosis may be delayed, due to the insidious onset of symptoms, development of abscess formation in the adjacent tissues, and disabiling neurological deficits [9][10][11]. Thus, early diagnosis is important.…”

Infectious Lesions of the Spine: Draft National Clinical Guidelines

“…Для инфекционных осложнений, возникших после операций (манипуляций) на позвоночнике, используют термин «инфекция области хирургического вмешательства на позвоночнике» (ИОХВп), соответствующий англоязычному понятию Surgical Site Infection in spinal surgery (SSIs). [20][21][22][23][24].…”