Chronic dialysis patients with infectious spondylodiscitis have poorer outcomes than non-dialysis populations

Abstract

PurposeInfectious spondylodiscitis is a serious disease that can lead to permanent neurological deficit. Because there were only a few case reports or series featuring infectious spondylodiscitis in chronic dialysis patients, we investigated the epidemiology and outcome in the chronic dialysis patients versus general population.Materials and methodsWe retrospectively identified chronic dialysis patients admitted for infectious spondylodiscitis between January 2002 and December 2015. A total of 105 chronic dialysis patients were included, and we performed a 1:2 case–control match on propensity score in non-dialysis patients with infectious spondylodiscitis. The demographic features, clinical manifestation, infection focus, and disease outcome were recorded.ResultsA total of 302 patients entered the final analysis. Chronic dialysis patients less frequently had fever (34.3%), and in the majority, bacterial entry was through dialysis vascular access (30.5%). Methicillin-resistant Staphylococcus aureus (MRSA) comprised the majority of causative pathogen. The chronic dialysis group had longer hospital stay, higher in-hospital mortality, and higher 1-year mortality. The odds ratio of in-hospital mortality was 2.20 compared with the non-dialysis group.ConclusionsThe study highlighted poorer outcome and high frequency of resistant Staphylococcus of infectious spondylodiscitis in chronic dialysis patients. Therefore, high vigilance, prompt recognition, and empiric coverage of MRSA will be important in the management of infectious spondylodiscitis in chronic dialysis patients.

Fatal neck pain in a patient on maintenance hemodialysis

“…9 Cervical IS patients are more likely to develop focal neurological symptoms (62.5%) than in other IS localizations. 3 Our patient was at high risk for spinal infection due to multiple comorbidities and recurrent vascular access problems. The last AVF manipulation dated back a month before IS occurred.…”

“…Minor neurological deficits are often missed 9 . Cervical IS patients are more likely to develop focal neurological symptoms (62.5%) than in other IS localizations 3 …”

“…According to a recent review, patients who developed IS had previous bacteremia of the same microorganism in 63% of cases, with SA being the most common pathogen agent (40.2%) 2 . In a retrospective review of 16 patients with cervical IS, MRSA was the primary pathogen in 31.2% of cases 3 …”

“…Despite the increasing incidence of infectious spondylodiscitis (IS) and the advancement of diagnostic tools, IS is still underdiagnosed in end‐stage renal disease (ESRD) dialysis patients 2 . Furthermore, the ambiguity of symptoms often results in diagnostic delays 3 …”

“…2 Furthermore, the ambiguity of symptoms often results in diagnostic delays. 3 Risk factors for IS other than ESRD include diabetes, endocarditis, degenerative spine disease, prior spinal surgery, corticosteroid therapy, and immunocompromised states. 4 Vascular access manipulation within 6 months before an episode of IS have been frequently noted; 75% of hemodialysis (HD) patients with IS were found to have undergone manipulation of their HD vascular access.…”