Infective spondylodiscitis in hemodialysis patients

Abstract

Background: Spondylodiscitis is a potentially catastrophic complication in patients on hemodialysis. It is slow and insidious onset and nonspecific symptoms have contributed to the late detection of this infectious process. Here, we reviewed the clinical characteristics and outcomes for patients on hemodialysis who developed spondylodiscitis who were diagnosed with spondylodiscitis. Methods: From 2011 to 2021, 11 (0.4%) of 2557 patients on hemodialysis were diagnosed with spondylodiscitis based on clinical symptoms, patients averaged 56.9 years of age, seven were male, and they presented with fever in just two cases. The most frequent comorbidities included hypertension (ten patients) and diabetes mellitus (seven patients). Here, we reviewed the clinical, radiological (i.e., MR scans), laboratory markers, and treatment choices (i.e., nonsurgical vs. surgical) for these 11 hemodialysis patients. Results: Ten of the 11 patients underwent spinal surgery, and five were later readmitted for recurrent of infections. There was just one nonsurgical mortality. Conclusion: For patients on hemodialysis, the new-onset of spinal pain may signal the onset of spondylodiscitis which should be rapidly diagnosed with MR studies and managed in a timely fashion either with antibiotic therapy and/or with surgery/antibiotics.

Antimicrobial Treatment Challenges in the Management of Infective Spondylodiscitis Associated with Hemodialysis: A Comprehensive Review of Literature and Case Series Analysis

“…Although ISD could be a possible cause of dorso-lumbar pain syndrome in HD patients, the lack of specificity of the clinical picture might lead to the underdiagnosis of this condition. The articles in the literature cite a series of ISD cases diagnosed in patients in HD programs, without registering enough patients to increase the statistical relevance of the carried-out studies [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. In the present study, we identified 13 patients with ISD (about 0.6% out of the 2157 dialyzed over the last 10 years), less than the data in the literature [ 57 ].…”

“…In conclusion, in ESRD patients MRSA has been found as a major etiology in several studies performed [19,38,39,[41][42][43][44][45][46][47][48][49]53]. Hemodialysis catheters and the period between diagnosis and admission were associated with resistance to medical treatment.…”