Metastatic Infections in Hemodialysis: An Analysis of 19 Cases

OBJECTIVE: Metastatic infection is a rare but serious complication in patients undergoing hemodialysis (HD). In this retrospective study, we aimed to analyze the clinical aspects, responsible microorganisms, treatments, and clinical outcomes in HD patients with metastatic infection

MATERIAL and METHODS: Metastatic infection was defined as infection that occurs at a location physically separate from the portal of entry of the bacteria. We identified 21 metastatic infections in 19 HD patients at our hospital from December 2010 through November 2016.

RESULTS: The mean age was 66.4 ± 15.7 years. Twelve (63.2%) of the 19 patients were female whereas 7 (36.8%) patients were male. Type of vascular access was tunneled cuffed permanent catheter in 15 (78.9%) and arteriovenous fistula in 4 (21.1%) patients. The most common type of metastatic infection was spondylodiscitis. In the majority of these patients, the responsible infectious agents were Gram-positive microorganisms including S. epidermidis and S. aureus. The clinical outcome in the majority of the patients was complete recovery. Two patients died due to metastatic infection.

CONCLUSION: Metastatic infection in HD patients, especially those with a tunneled cuffed permanent catheter, is a serious complication, which may result in the patient’s death. Gram-positive microorganisms are responsible for the majority of cases with metastatic infection.