HDCN Article Review/Hyperlink

Kovalik EC, Raymond JR, Albers FJ, Berkoben M, Butterly DW, Montella B, Conlon PJ

A clustering of epidural abscesses in chronic hemodialysis patients: risk of salvaging access catheters

J Am Soc Nephrol (Oct) 7:2264-2267 1996

In January of this year, Obrador and Levenson presented a review of 12 cases of spinal epidural abscess in hemodialysis patients. This is a serious condition often resulting in permanent paralysis or death. In that series, etiology was either an infected graft or infected skin ulcer.

In the present paper, Kovalik et al examined all cases of epidural abscess occuring in dialysis patients over a 5-year period, and found 10 such patients. The only consistent complaint was severe, debilitating back pain. Eight of the 10 patients had chronic dual- lumen venous catheters in place at time of infection, and five patients had recently received or were receiving antibiotics for catheter salvage at the time due to documented Staph infection. The results of treatment were happier here than in the Obrador/Levenson paper with no deaths, 4 patients successfully treated conservatively, and neurologic sequelae (apparently mild) in only 3 or the 10 patients.

Comment: Attempted salvage of infected venous catheters by antibiotic therapy while leaving the catheter in place is a popular and often necessary therapeutic choice. This report describes one of the potential risks of this strategy (osteomyelitis and endocarditis being others). I don't know why the Obrador/Levenson paper was not cited. It would have been nice to have seen a denominator: i.e., how many patients were treated for catheter salvage in toto? Ten had this severe complication: how many had no complication? (John T. Daugirdas, M.D., University of Illinois at Chicago)