Chronic dialysis patients with infectious spondylodiscitis have poorer outcomes than non-dialysis populations

George Kuo,1 Wei-Chiao Sun,1 Yueh-An Lu,1 Chao-Yu Chen,1 Huang-Kai Kao,2 YuJr Lin,3 Yung-Chang Chen,4 Cheng-Chieh Hung,1 Ya-Chung Tian,1 Hsiang-Hao Hsu1 1Department of Nephrology, Kidney Research Center, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; 2Department of Plastic and Reconstructive Surgery, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; 3Center for Big Data Analytics and Statistics, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; 4Department of Internal Medicine, Division of Nephrology, College of Medicine, Keelung Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan Purpose: Infectious spondylodiscitis is a serious disease that can lead to permanent neurological deficit. Because there were only a few case reports or series featuring infectious spondylodiscitis in chronic dialysis patients, we investigated the epidemiology and outcome in the chronic dialysis patients versus general population.Materials and methods: We retrospectively identified chronic dialysis patients admitted for infectious spondylodiscitis between January 2002 and December 2015. A total of 105 chronic dialysis patients were included, and we performed a 1:2 case–control match on propensity score in non-dialysis patients with infectious spondylodiscitis. The demographic features, clinical manifestation, infection focus, and disease outcome were recorded.Results: A total of 302 patients entered the final analysis. Chronic dialysis patients less frequently had fever (34.3%), and in the majority, bacterial entry was through dialysis vascular access (30.5%). Methicillin-resistant Staphylococcus aureus (MRSA) comprised the majority of causative pathogen. The chronic dialysis group had longer hospital stay, higher in-hospital mortality, and higher 1-year mortality. The odds ratio of in-hospital mortality was 2.20 compared with the non-dialysis group.Conclusions: The study highlighted poorer outcome and high frequency of resistant Staphylococcus of infectious spondylodiscitis in chronic dialysis patients. Therefore, high vigilance, prompt recognition, and empiric coverage of MRSA will be important in the management of infectious spondylodiscitis in chronic dialysis patients. Keywords: end stage renal disease, pyogenic spondylodiscitis, infectious spondylodiscitis, methicillin-resistant Staphylococcus aureus, mortality