Kidney Week

Abstract: TH-PO884

Epidemiology and Outcomes of Infective Spondylodiscitis in Hemodialysis Patients

Session Information

• Dialysis: Infection
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 610 Dialysis: Infection

Authors

• Lu, Yuehan, Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital; College and School of Medicine, Chang Gung University, Taiwan, Taoyuan, Taiwan

Yuehan Lu,

• Kuo, George, Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital; College and School of Medicine, Chang Gung University, Taiwan, Taoyuan, Taiwan

George Kuo,

• Chen, Chao-Yu, Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital; College and School of Medicine, Chang Gung University, Taiwan, Taoyuan, Taiwan

Chao-Yu Chen,

• Hsu, Hsiang-Hao, Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital; College and School of Medicine, Chang Gung University, Taiwan, Taoyuan, Taiwan

Hsiang-Hao Hsu,

Background

Infective spondylodiscitis, defined as the pathogenic invasion of vertebra and intervertebral disc, is an uncommon but serious disease. As the disease progresses, patients develop neurological deficits, sepsis, and even mortality. Microorganisms reach vertebra and intervertebral discs in different ways, including antegrade bacteremia from the blood stream, retrograde infection from the urinary tract and direct invasion from contiguous tissue or a surgical procedure. Patients on maintenance hemodialysis (HD) have additional risk factors that contribute to blood stream infection because of the repeated vascular puncturing, long-term catheter or Gore-Tex graft indwelling, and contamination of dialysis water purification system. The characteristics and outcomes of infective spondylodiscitis in HD patients may be different from those in the general population.

Methods

The cases of 1,402 patients who were hospitalized for infective spondylodiscitis in a 13 year period in a tertiary hospital were retrospectively reviewed. Of these, 102 patients on maintenance HD were enrolled in this study. Cox’s proportional hazard model was used to evaluate the risk factors of mortality and recurrence.

Results

The 102 enrolled patients had an average age 63.3±11.2 years old and male-to-female ratio of 1:1.04. Back pain was present in 75.5% of patients and the most commonly infected site was the lumbosacral spine. Infection associated with vascular access was identified in 31.4% of patients and the use of dialysis via central venous catheters was three times higher than in outpatient cohort. Methicillin-resistant S. aureus was the most common pathogen, followed coagulase-negative staphylococci. The patients’ in-hospital survival rate was 82.4%; their vascular access survival was 75.5% their one-year survival was 78.4% and their one-year recurrence rate was 20.2%. Congestive heart failure was associated with an increased one-year mortality. Other variables exhibited no significant relationship with patients’ in-hospital mortality, one-year mortality or recurrence.

Conclusion

The characteristics and outcomes of infective spondylodiscitis in HD patients were elucidated. Most of the demographic and clinical variables, evaluated upon admission, did not predict mortality or recurrence. An algorithm for the diagnosis and treatment of infective spondylodiscitis in an HD cohort is provided.