title: Infective spondylodiscitis in patients on maintenance hemodialysis: a case series.
abstract: Infective spondylodiscitis is a rare disease. This case review describes the clinical course, risk factors, and outcomes of adult patients on maintenance hemodialysis who presented with infective spondylodiscitis at a single medical center in Taiwan. There were 18 cases (mean age: 64.9 ± 10.8 years) over more than 10 years. Analysis of underlying diseases indicated that 50% of patients had diabetes, 55.6% had hypertension, 55.6% had coronary artery disease, 22.2% had congestive heart failure, 22.2% had a cerebral vascular accident, 16.7% had liver cirrhosis, and 11.1% had malignancies. Sixty-one percent of patients had a degenerative spinal disease and the most common symptom was back pain (83.3%). A total of 38.9% of patients had leukocytosis, 99.4% had elevated levels of C-reactive protein, 78.6% had elevated erythrocyte sedimentation rates, and 55.6% had elevated levels of alkaline phosphatase. The average hemodialysis duration was 72.8 ± 87.5 months, and 8 patients (44.4%) started hemodialysis within 1 year prior to infective spondylodiscitis. Four patients (22.2%) had vascular access infection-associated spondylodiscitis. The lumbar region was the most common location of infection (77.8%), 44.4% of patients developed abscesses, and Staphylococci were the most common pathogen (38.9%). The mortality rate was 16.7%, all due to sepsis. Thirty-three percent of the survivors had recurrent infective spondylodiscitis within 1 year. Infective spondylodiscitis should be considered in hemodialysis patients who present with prolonged back pain with or without fever. Non-contrast MRI is an appropriate diagnostic tool for this condition. Vascular access infection increases the risk for infective spondylodiscitis in hemodialysis patients.
authors.affiliation: a Department of Nephrology , College of Medicine, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University , Taoyuan , Taiwan.
authors.forename: Yueh-An
authors.initials: YA
authors.lastname: Lu
authors.affiliation: a Department of Nephrology , College of Medicine, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University , Taoyuan , Taiwan.
authors.forename: Hsiang-Hao
authors.initials: HH
authors.lastname: Hsu
authors.affiliation: b Department of Plastic and Reconstructive Surgery , College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University , Taoyuan , Taiwan.
authors.forename: Huang-Kai
authors.initials: HK
authors.lastname: Kao
authors.affiliation: c Department of Pharmaceutical Materials Management , Taoyuan Chang Gung Memorial Hospital , Taoyuan , Taiwan.
authors.forename: Chia-Hui
authors.initials: CH
authors.lastname: Lee
authors.affiliation: a Department of Nephrology , College of Medicine, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University , Taoyuan , Taiwan.
authors.forename: Shen-Yang
authors.initials: SY
authors.lastname: Lee
authors.affiliation: a Department of Nephrology , College of Medicine, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University , Taoyuan , Taiwan.
authors.forename: Guan-Hsing
authors.initials: GH
authors.lastname: Chen
authors.affiliation: a Department of Nephrology , College of Medicine, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University , Taoyuan , Taiwan.
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Hung
authors.affiliation: a Department of Nephrology , College of Medicine, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University , Taoyuan , Taiwan.
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
mesh_terms: D000038:Abscess / Q000188:drug therapy* / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001416:Back Pain / Q000209:etiology; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D015299:Discitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein; D000469:Alkaline Phosphatase
keywords: C-reactive protein; Infective spondylodiscitis; backache; hemodialysis; sepsis