Epidural Abscesses in ESRD Patients

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Infectious metastases (e.g., infective endocarditis, epidural abscess, liver & lung abscesses, etc) are unfortunately not uncommon in the ESRD population, particularly in those with in-dwelling catheters.  I have personally seen several cases of epidural abscesses as a fellow, a complication which can be neurologically devastating and nearly impossible to treat.  Clearly, prevention is the key issue.

A small but instructive case series from Kovalik et al in a 1996 issue of JASN reviewed all the cases of dialysis patients with epidural abscess over a 5-year period within the Duke health care system.  Of the 10 patients identified, the majority (8) had catheters, 5 of whom with known bacteremia with an attempt to treat the infection with antibiotics alone.  The lesson, if you haven’t learned it by now:  catheter-associated bacteremia virtually always should be treated with a line change, as there are significant risks to doing otherwise.  

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