Abstract
[Purpose] Pyogenic spondylitis often develops in elderly and compromised hosts and the number of cases has increased. In recent years, there have been many reports of pyogenic spondylitis especially in dialysis patients. To clarify the incidence and features of pyogenic spondylitis in dialysis patients, we mainly studied dialysis patients in the general population who were diagnosed with pyogenic spondylitis in our hospital. [Methods] A retrospective study was performed in 27 patients (22 males and 5 females, mean age±SD 66±12 years (49~89)) who were diagnosed with pyogenic spondylitis and treated in our orthopedic department between October 2003 and October 2008. We analyzed age, underlying disease, disease background, affected site, causative microorganism, presence or absence of abscess, therapy, and other factors. By comparing these survey items between dialysis patients and general patients, we demonstrated specific features in dialysis patients and analyzed the ratio of underlying disease. [Results] Of the 27 patients, 5 (18.5%) were receiving hemodialysis. Pyogenic spondylitis developed due to puncture site infection, catheter infection, or bacteremia after vascular graft surgery in 3 of the 5 patients and due to local infection after lumbar spine surgery in the other 2. While the average age at onset was 68±11 (mean±SD) years in non-dialysis patients, it was 56±7 (mean±SD) years old in dialysis patients, showing a younger onset (p value: 0.020). The causative microorganism could be identified in 15 patients, and Staphylococci including MRSA were the most frequently observed pathogen (10 patients, 67%). [Conclusions] The percentage of patients on hemodialysis as an underlying disease was higher than expected, and showed a younger onset in diaysis patients than in non-dialysis patients. We showed the importance of the disease statistically in the differential diagnosis of fever in dialysis patients presenting with back pain.
