Spondylodiscitis in hemodialysis patients: a case series

Faria, Bernardo; N, Canto Moreira; Tc, Sousa; Pêgo, Cátia; Vidinha, Joana; Garrido, Jesús; Lemos, Sérgio; Soares, Cristina M. Bouissou; Lima, Cyndi Fernandes de; Sorbo, Giovanni Del; E, Lorga Gomes

doi:10.5414/cn106525

Cited by 13 publications

(15 citation statements)

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“…reported that 91% of cases with spondylodiscitis in a HD cohort used a central venous catheter instead of an arteriovenous shunt for vascular access. 7 Another study reported that establishment of a new central venous dialysis catheter within 6 months prior to diagnosis was a significant risk factor for spondylodiscitis. 8 Also, ESRD and/or HD might disrupt the innate or the adaptive immune response, resulting in an increased susceptibility to infectious disease.…”

Section: Discussionmentioning

confidence: 99%

“… 6 , 11 , 12 Only one study reported that fever was the most frequent initial presentation, but almost all patients in that study eventually developed back pain during hospitalization. 7 …”

Section: Discussionmentioning

confidence: 99%

“…Previous research reported the rate of endocarditis is 2.6% in the general population, 17 but was 18% in a small series of HD patients. 7 …”

Section: Discussionmentioning

confidence: 99%

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Infective spondylodiscitis in patients on maintenance hemodialysis: a case series

Hsu

Kao

et al. 2016

Renal Failure

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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.

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Section: Discussionmentioning

confidence: 99%

“… 6 , 11 , 12 Only one study reported that fever was the most frequent initial presentation, but almost all patients in that study eventually developed back pain during hospitalization. 7 …”

Section: Discussionmentioning

confidence: 99%

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Infective spondylodiscitis in patients on maintenance hemodialysis: a case series

Hsu

Kao

et al. 2016

Renal Failure

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“…The presence of a CVC and a history of multiple vascular accesses may be important risk factors. Prolonged antibiotic therapy with initial broadspectrum coverage seems to be the best therapeutic approach [113] . Infective endocarditis should be suspected when HD patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed.…”

Section: Mortality and Morbidity Of Vascular Accessmentioning

confidence: 99%

Vascular access today

Pantelias

Grapsa²

2012

WJN

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The number of patients with chronic kidney disease requiring renal replacement therapy has increased worldwide. The most common replacement therapy is hemodialysis (HD). Vascular access (VA) has a key role for successful treatment. Despite the advances that have taken place in the field of the HD procedure, few things have changed with regards to VA in recent years. Arteriovenous fistula (AVF), polytetrafluoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common complications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunction is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the first choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the first choice, followed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most important issue for patients on HD and despite the technical improvements, a number of problems and complications have to be resolved.

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“…More recently, vancomycin and gentamycin use have been suggested as best in a series where 8 of 11 patients grew Staphylococcus aureus 2. Commentators have lamented the absence of controlled trials and lack of guidelines for treatment of spondylodiscitis in general 12.…”

Section: Discussionmentioning

confidence: 99%

Low back pain in a diabetic on chronic haemodialysis: pyogenic spondylodiscitis

et al. 2014

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Spondylodiscitis of the lumbar spine is described in a 67-year-old-man receiving chronic haemodialysis via a central venous catheter for diabetic nephropathy. He also had a forearm arteriovenous fistula created 1 month earlier. Clinical, MRI and surgical findings are described. The patient died despite spinal surgery and 1 month of antibiotic therapy from suspected pulmonary embolism. Early recognition by MRI or other imaging technique, prompt antibiotic therapy and often surgery are necessary for a successful outcome in this increasingly recognised complication in patients on chronic haemodialysis. Diabetes mellitus may be an added risk factor.

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Spondylodiscitis in hemodialysis patients: a case series

Cited by 13 publications

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Infective spondylodiscitis in patients on maintenance hemodialysis: a case series

Infective spondylodiscitis in patients on maintenance hemodialysis: a case series

Vascular access today

Low back pain in a diabetic on chronic haemodialysis: pyogenic spondylodiscitis

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