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Infectious Spondylodiscitis (ISD) in patients on hemodialysis (HD) is a disease with a high morbidity and mortality whose frequency is increasing due to the higher rate of bacteremia, use of vascular access (VA) and increased life expectancy. This population has risk factors for developing infections, such as advanced age, multiple pathologies, uremia, incompatibility with HD membrane, malnutrition and anemia. ISD is mainly related to vascular access infections (VAI), which spread hematogenously. The initial symptoms are usually insidious and nonspecific. Its diagnosis requires a high index of suspicion, as early treatment determines its evolution and prognosis. The objectives of this work are to analyze whether comorbidities, age of VA, HD onset, intensive care unit (ICU) stay and serious complications (septic shock, spinal cord syndrome, endocarditis, hematogenous seeding) influence mortality; to evaluate the frequency of previous VAI, initial symptoms and their evolution time upon admission, as well as to describe the local epidemiology.
Retrospective, descriptive and analytical study of patients admitted to the Hospital Provincial del Centenario, Rosario, Argentina between 2013 - 2023, with ISD on chronic HD. We reviewed medical records and age, sex, comorbidities, type of VA, length of time on HD, history of VAI, symptoms of presentation and time of evolution, isolated pathogen, location of ISD, associated complications, hospital stay, and mortality were evaluated. Statistical analysis was performed with IBM SPSS, using chi-square, logistic regression of each variable and Student’s T test.
Of the 39 patients hospitalized with spondylodiscitis, 14 were on HD. Of these, 71.4% were men, with a mean age of 59±6 years. The most frequent comorbidities were DM 78.6%, HTN 78.6% and smoking 64.3%; 71.4% had a history of VAI and 85.7% had bacteremia. 78.6% had lumbar location and the most frequent pathogen was Staphylococcus (graph 1). The predominant VA was AV Graft (graph 2), and the cardinal symptom was pain (graph 3) Regarding mortality, this was 28.6%, and the statistically significant variables were age of the VA (p 0.02) (graph 4), with a median of 7 months (range 1-72), serious complications (p 0.04) (graph 5) and length of stay in ICU (p 0.05) (table 1). On the other hand, the time of HD initiation (median 10 months) was not significant (p 0.67), nor were the other variables analyzed individually.
Spondylodiscitis in HD patients is a serious disease often underdiagnosed. Regarding the causative pathogens and localization, there was no difference with other institutions. Greater mortality was evident in recently made VA, regardless of the type of VA, which is why we highlight the importance of frequent monitoring. Serious complications and ICU stay were also related to higher mortality. Although there were no statistically significant differences, a trend was observed in the time of symptoms onset that was greater in patients who died, which is why we emphasize timely diagnosis and early treatment (graph 6). There are few reports worldwide on this topic, hence we highlight the importance to continue investigating and delve deeper into this pathology.