Impact of Vascular Access Type on Bacteremia and Outcomes in Hemodialysis Patients With Surgically Treated Spondylodiscitis

Background Spondylodiscitis is a severe complication in patients undergoing hemodialysis, often associated with bacteremia and high mortality. Vascular access type may influence infection burden and clinical outcomes; however, data on its role in surgically treated spondylodiscitis remain limited. Methods This retrospective single-center study included 17 hemodialysis patients who underwent surgery for spondylodiscitis between 2019 and 2024. Patients were grouped according to vascular access type: arteriovenous fistula (AVF) or tunneled catheter. Demographic characteristics, microbiological findings, pathological results, surgical management, and clinical outcomes were analyzed. Results Thirteen patients (76.5%) were catheter-dependent, while four patients (23.5%) had an AVF. Positive blood cultures were observed exclusively in catheter-dependent patients, whereas no bacteremia was detected in AVF patients. All cases of pathological discitis, neurological involvement, prolonged intravenous antibiotic therapy, and mortality occurred in the catheter group. AVF patients demonstrated shorter treatment duration and favorable clinical outcomes. Conclusion Vascular access type appears to be a critical and potentially modifiable determinant of infection severity and prognosis in hemodialysis patients with spondylodiscitis. Preferential use of arteriovenous fistulas may reduce bacteremia, neurological complications, and mortality in this high-risk population.