title: Endocarditis and spondylodiscitis associated with tunneled cuffed hemodialysis catheters: hospitalizations with poor outcomes.
abstract: BACKGROUND
  Patients undergoing chronic hemodialysis using tunneled cuffed catheters (TCCs) are at increased risk of metastatic infections, namely endocarditis and spondydodiscitis, and mortality is high in this group. The aim of this study was to determine the clinical features, causative organisms, its susceptibility and outcomes in patients hospitalized with these infections from a single center.
  
  
  METHODS
  All consecutive patients with TCC and endocarditis and/or spondylodiscitis treated at the authors' institution between 2005 and 2011 were selected retrospectively.
  
  
  RESULTS
  A total of 7 cases of endocarditis and 7 cases of spondylodiscitis were diagnosed. Concurrent infection was present in 1 patient. The mean age was 63.4 years, 53.8% were male, 23% had diabetes and 31% had previous immunosuppression. The average time on hemodialysis was 24 months. Those patients with endocarditis presented with fever, and 43% had previous valvular disease; mitral valve involvement was the most common. Early surgery was performed in 2 patients.Concerning spondylodiscitis, the median time from first symptom to diagnosis was 48 days. The first manifestation was back pain in 86% percent of patients, and 71% had an epidural or paraspinous abscess demonstrated by neuroimaging. One patient underwent surgical drainage of the abscess. Regarding both infections, staphylococcus aureus was the most common causative agent with a lower rate of negative blood cultures. All patients received intravenous antibiotics for a mean duration of six weeks. The mortality rate was 46%.
  
  
  CONCLUSIONS
  A high index of suspicion is critical in the early recognition and management of both of these infections.
authors.affiliation: 1 Department of Nephrology, Centro Hospitalar do Porto, Porto - Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Rocha
authors.forename: Rui
authors.initials: R
authors.lastname: Castro
authors.forename: Josefina
authors.initials: J
authors.lastname: Santos
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000145:classification; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D015299:Discitis / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D019468:Disease Management; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D017063:Outcome Assessment, Health Care; D011174:Portugal / Q000453:epidemiology; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D061665:Time-to-Treatment
chemical_list: D000900:Anti-Bacterial Agents