Metastatic spondylodiscitis in central venous catheter related bloodstream infections in hemodialysis patients: Risk factors and prognosis.

Background: Infection is one of the most common causes of death in hemodialysis patients. Catheter infections are among the most common infections in this patient group. Spondylodiscitis which has a high incidence in ESRD is more commonly encountered in patients with CVCs compared to AVF. In this study, we aimed to evaluate the frequency and risk factors of spondylodiscitis in catheter-related bloodstream infections in hemodialysis patients.

Methods: In total, 1620 patients were screened and 42 male and 35 female patients with central catheter infection with a mean age of 65.8 ± 14.9 years were included in this study. Patients with metastatic infections secondary to CVC related bloodstream infections were determined. The diagnosis of spondylodiscitis was based on clinical information, computed tomography (CT) and magnetic resonance imaging (MRI), and vertebral cultures.

Results: Metastatic infection due to catheter infection was observed in 15 patients (19.5%). In the regression analysis, CRP level and RRT time were found to be significantly correlated with the development of metastatic infection. Spondylodiscitis was the most common subtype of metastatic infections (8/15). The presence of lumbar hernia was associated with increased risk of metastatic spondylodiscitis in case of catheter infection in hemodialysis patients. The only factor associated with resistance to medical treatment was the time from admission to diagnosis.

Conclusion: Patients with long RRT time and high blood CRP levels on admission should be closely monitored for metastatic infection in patients with CVC related bloodstream infections. Screening for spondylodiscitis with CT or MRI should be performed in patients with symptoms, since early diagnosis may prevent the development of possible neurological deficits and treatment resistance.