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Epidural Abscess Dialysis Catheter — ESENeph MCQ

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ModerateHaemodialysisEpidural Abscess Dialysis CatheterESENeph

A 65-year-old man on haemodialysis develops acute onset back pain with progressive lower limb weakness and urinary retention. MRI spine shows an epidural abscess at L3-L4. Blood cultures grow MRSA. He has a tunnelled haemodialysis catheter. What is the most likely source?

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Correct answer: B — Haematogenous seeding from the infected tunnelled catheter

Epidural abscess in haemodialysis patients is most commonly due to haematogenous seeding from vascular access infections (tunnelled catheters are highest risk). Staphylococcus aureus (including MRSA) is the most common organism. The tunnelled catheter is the most likely source. Management involves urgent neurosurgical assessment (decompression if neurological deficit), prolonged IV antibiotics (6-8 weeks), and catheter removal. Native AV fistula has much lower infection risk.

Reference: UKKA 2019 – Vascular Access; Darouiche 2006 – Spinal Epidural Abscess