Spondylodiscitis in patients under haemodyalisis

Cerván, Ana María; Colmenero, Juan; Arco, Alfonso del; Villanueva, Francisco Javier Sánchez; Guerado, Enrique

doi:10.1007/s00264-011-1433-1

Cited by 41 publications

(42 citation statements)

References 24 publications

(35 reference statements)

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“…Besides a relative increase in pyogenic spondylodiscitis, there also appears to be an increase in the total incidence [1,3,7,8]. This increase in incidence is thought to be caused by the aging population, by the rise of immunosuppressed patients, of intravenous drug use and of improved diagnostic possibilities [1,3,7,8].…”

Section: Introductionmentioning

confidence: 99%

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

et al. 2015

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Background Spondylodiscitis is a spinal infection affecting primarily the intervertebral disk and the adjacent vertebral bodies. Currently many aspects of the treatment of pyogenic spondylodiscitis are still a matter of debate. Purpose The aim of this study was to review the currently available literature systematically to determine the outcome of patients with pyogenic spondylodiscitis for conservative and surgical treatment strategies. Methods A systematic electronic search of MEDLINE, EMBASE, Cochrane Collaboration, and Web of Science regarding the treatment of pyogenic spondylodiscitis was performed. Included articles were assessed on risk of bias according the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and strength of recommendation was evaluated according the GRADE approach. Results 25 studies were included. Five studies had a high or moderate quality of evidence. One RCT suggest that 6 weeks of antibiotic treatment of pyogenic spondylodiscitis results in a similar outcome when compared to longer treatment duration. However, microorganism-specific studies suggest that at least 8 weeks of treatment is required for S. aureus and 8 weeks of Daptomycin for MRSA. The articles that described the outcome of surgical treatment strategies show that a large variety of surgical techniques can successfully treat spondylodiscitis. No additional long-term beneficial effect of surgical treatment could be shown in the studies comparing surgical versus antibiotic only treatment. Conclusion There is a strong level of recommendation for 6 weeks of antibiotic treatment in pyogenic spondylodiscitis although this has only been shown by one recent RCT. If surgical treatment is indicated, it has been suggested by two prospective studies with strong level of recommendation that an isolated anterior approach could result in a better clinical outcome.

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Section: Introductionmentioning

confidence: 99%

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

et al. 2015

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“…Similarly, the majority of our patients had a tunneled cuffed permanent catheter for vascular access. HD patients may present with spondylodiscitis as a result of bacteraemia, since the thoracic spine is one of the most frequent locations of bacterial colonization (8,11). Similarly, the type of metastatic infection in about half of our patients was spondylodiscitis.…”

Section: Discussionmentioning

confidence: 87%

“…HD patients have high risk of infection from complications of bacteraemia, which usually originates from the vascular contamination by central venous catheters or routine skin penetration for blood access (8,9). The frequency of bacteremia is greater in HD patients with indwelling tunneled catheters than in those with either AVF or synthetic graft (10).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Metastatic Infections in Hemodialysis: An Analysis of 19 Cases

Ünal¹,

Arıkan²,

Sipahioğlu³

et al. 2017

Turk Neph Dial Transpl

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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.

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“…Cheung and Luk, Zarghooni et al and Guerado and Cervan [24][25][26] each wrote a review article about the incidence and treatment of spondylodiscitis in adults, Cheung and Luk [24] describe in detail the clinical and diagnostic protocols to follow in these cases, Zarghooni et al [25] present a treatment algorithm and Guerado and Cervan [26] discusses surgical controversies. Cervan et al [27] collected an important number of spondylodiscitis in patients on haemodialysis. The diagnosis is frequently made very late; MR is the best way to diagnose and localise the focus in this serious complication in dialysis patients, for whom the authors recommend prompt surgery.…”

mentioning

confidence: 99%