Spondylodiscitis in hemodialysis patients: a case series

Background: Although bacterial spondylodiscitis is one of the most serious complications in hemodialysis patients, it is often underdiagnosed, and few reports describe its course and clinical management. Patients and methods: We retrospectively reviewed 11 hemodialysis patients diagnosed with spondylodiscitis, during a 5-year period, and compared them with the general population followed at our center. Nine patients presented with fever on admission. Blood cultures were positive in all patients and Staphylococcus aureus was identified in 8. Ten patients had a central venous catheter as access for hemodialysis and the number of vascular accesses in the patients' medical history was superior to the rest of our HD population. Results: Four patients (36%) died during follow-up. None of the patients that underwent vancomycin and gentamicin antibiotic therapy died. Conclusion: Bacterial spondylodiscitis must be suspected whenever a patient on hemodialysis is admitted with fever and/or back pain. The presence of a central venous catheter and a history of multiple vascular accesses may be important risk factors. Prolonged antibiotic therapy with initial broad-spectrum coverage seems to be the best therapeutic approach.