Investigation of preoperative asymptomatic bacteriuria as a risk factor for postvertebroplasty infection

Abstract

Vertebroplasty (VP) has gained in popularity as an effective treatment for painful osteoporotic vertebral fracture since its introduction by Galibert in 1987. 1 Although the procedure is generally safe and effective, catastrophic complications such as post-VP infection (PVI) occur at a rate of 0.32% to 0.46%. [2][3][4] Surgical management of PVI often requires an anterior approach to remove the cement, anterior fusion, and posterior instrumentation. This aggressive procedure is not well tolerated in aged and frail patients. The mortality rate of PVI is 10% to 33%. 2,3 With less than 60 cases reported to date, the potential risk factors for PVI remain elusive. 2 In primary vertebral osteomyelitis, hematogenous seeding from distant sites via the arterial route is the predominant pathway for pathogen infection of the vertebral column. Sites of infection that result in hematogenous spread include the respiratory tract, gastrointestinal tract, skin and soft tissue, and, most often, urinary tract infection (UTI). 5 Thus, VP is contraindicated in patients with active infection. 6 Asymptomatic bacteriuria (ASB), a condition that does not require treatment in most cases, 7 is another potential concern when considering VP. While ASB is found to be a risk factor for prosthetic joint infection, [8][9][10] the relationship between ASB and PVI is unknown.This study aims to investigate the incidence of ASB among patients who underwent VP to treat painful osteoporotic vertebral fractures, identify the risk factors for PVI, and determine whether ASB is a risk factor for PVI. METHODS Study design and populationThis study was approved by the institutional review board of our hospital (2020-02-013AC). A prospectively compiled database of patients who were admitted as VP candidates for the treatment of painful osteoporotic vertebral fractures between May 2015 and December 2019 was retrospectively analyzed to select the study cohort. Patients were excluded from the study