Metastatic Infections in Hemodialysis: An Analysis of 19 Cases

Abstract

OBJECTIVE:Metastatic infection is a rare but serious complication in patients undergoing hemodialysis (HD). In this retrospective study, we aimed to analyze the clinical aspects, responsible microorganisms, treatments, and clinical outcomes in HD patients with metastatic infection MATERIAL and METHODS: Metastatic infection was defined as infection that occurs at a location physically separate from the portal of entry of the bacteria. We identified 21 metastatic infections in 19 HD patients at our hospital from December 2010 through November 2016. RESULTS:The mean age was 66.4 ± 15.7 years. Twelve (63.2%) of the 19 patients were female whereas 7 (36.8%) patients were male. Type of vascular access was tunneled cuffed permanent catheter in 15 (78.9%) and arteriovenous fistula in 4 (21.1%) patients. The most common type of metastatic infection was spondylodiscitis. In the majority of these patients, the responsible infectious agents were Gram-positive microorganisms including S. epidermidis and S. aureus. The clinical outcome in the majority of the patients was complete recovery. Two patients died due to metastatic infection. CONCLUSION:Metastatic infection in HD patients, especially those with a tunneled cuffed permanent catheter, is a serious complication, which may result in the patient's death. Gram-positive microorganisms are responsible for the majority of cases with metastatic infection. BULGULAR: Ortalama yaş 66.4 ± 15.7 yıldı. On dokuz hastanın 12'si (%63.2) kadın, 7'si (%36.8) erkekti. Damara ulaşım yolunun türü 15 (%78.9) hastada tünelli keçeli kalıcı kateter ve 4 (%21.1) hastada arteriyovenöz fistüldü. En sık görülen metastatik enfeksiyon türü spondilodiskitti. Hastaların çoğunda sorumlu enfeksiyon ajanları S. epidermitis and S. aureus gibi Gram-pozitif mikroorganizmalardı. Hastaların çoğunda klinik sonuç tam iyileşme idi. İki hasta metastatik enfeksiyon nedeniyle kaybedildi. SONUÇ:Özellikle tünelli keçeli kalıcı kateteri olan HD hastalarında metastatik enfeksiyon ciddi bir komplikasyondur ve hastanın kaybedilmesine neden olabilir. Gram-pozitif mikroorganizmalar metastatik enfeksiyonlu olguların çoğundan sorumludur.

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 ].…”

“…The antibiotic regimen for the HD patients was based on Vancomycin administration (61.53% HD vs. 38.88% non-HD). The choice of Vancomycin in patients with negative cultures was based on the etiology most frequently reported in the literature [ 19 , 38 , 39 , 40 , 43 ]. Vancomycin was used for 2–4 weeks and was later replaced with other anti- staphylococcal agents (Clindamycin, Ciprofloxacin, Amikacin).…”

“…The antibiotic treatments were either empiric or adapted to the antibiogram. The length of the antibiotic therapy should have been mentioned [ 43 ].…”

“…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.…”