ENTEROCOCCUS CAUSING LUMBAR EPIDURAL ABSCESS IN A PATIENT UNDERGOING HEMODIALYSIS VIA A TUNNELLED CATHETER: A CASE FROM A TERTIARY MEDICAL CENTRE IN INDIA

Abstract

Intro: Tunneled catheters are a lifeline in ESRD patients undergoing hemodialysis. Intravascular access devices have significant potential for producing iatrogenic diseases resulting in catheter related blood stream infections (CRBSI). CRBSI, a nosocomial infection is a significant clinical problem which is continuously evolving. They are associated with significant morbidity, mortality, and cost. The risk factors for blood stream infections in tunneled cuffed catheters include the duration of the catheter, past catheter related bacteraemia, hypoalbuminemia, immunosuppression. Gram positive organisms are the most common causative pathogens. Staph aureus CRBSI is more likely to require hospitalization or ICU admission. Metastatic infection like infective endocarditis, osteomyelitis, septic arthritis, spinal epidural abscess is relatively uncommon and most reported cases are caused by Staphylococcus aureus. Treatment of complicated CRBSI with sepsis, persistently positive blood cultures, or metastatic infection requires a longer course of antibiotics (6–8 weeks) compared with uncomplicated CRBSI. Methods: A 67 year old patient on dialysis via a tunneled catheter for 3 months duration presented with complaints of severe lower back pain. Blood cultures from catheter site and peripheral site grew Enterococcus fecalis. MRI spine was suggestive of epidural abscess. The tunneled catheter was removed and antibiotics were given based on the sensitivity reports. Findings: The differential diagnoses were multiple myeloma, TB spine, secondaries spine, osteoporosis. MRI contrast clinched the diagnosis of spinal epidural abscess, which is very uncommonly caused by Enterococcus fecalis. Conclusion: Atypical presentation of CRBSI should be kept in mind in all patients on intravascular access devices. Appropriate treatment with antibiotics and removal of the catheter is to be done if metastatic infection is present.