| [ Summary ] |
Patients receiving chronic dialysis therapy have compromised host defenses and impaired organ blood flow, which can lead to an increased risk of infections. Pyogenic osteomyelitis, spondylitis, and necrotizing soft tissue infections are serious and sometimes lethal diseases. Pyogenic arthritis and osteomyelitis are likely to be associated with surgical intervention. On the other hand, pyogenic spondylitis is likely to occur in compromised hosts who have not experienced trauma or surgery. There is no obvious symptom of pyogenic spondylitis except severe bachache. Thus, MRIs may be the only method for early diagnosis. Necrotizing soft tissue disease, unlike cellulitis, is not curable with antibiotic therapy alone. Timely surgical debridement with removal of infected tissue is crucial for infection control and patient survival.
Methicillin-resistant Staphylococcus aureus (MRSA) infections are also common and life-threatening in dialysis patients. For prophylaxis, vascular access should be in a native arteriovenous fistula whenever possible. Patients should adopt good personal hygiene habits, and dialysis staffs must be well trained in needle insertion. Linezolid, a newly developed antibiotic, may be useful for MRSA bone infections. |