# Intraoperative Incidence of Bacteremia During Surgical Management of Non-tubercular Spondylodiscitis: A Prospective Analysis

## TL;DR

This study found that surgical procedures for spinal infections rarely cause bacteremia, but more research is needed due to a small sample size.

## Contribution

The study is the first to prospectively analyze intraoperative bacteremia during surgery for non-tubercular spondylodiscitis.

## Key findings

- Intraoperative blood cultures were positive in 12.5% of patients.
- Only one patient had matching preoperative and intraoperative blood cultures with MRSA.
- The overall bacteremia rate was low, indicating limited bloodstream entry during surgery.

## Abstract

Introduction

Non-tubercular spondylodiscitis is a serious spinal infection that can lead to significant morbidity. The potential for bacteremia during surgical manipulation of infected disc material has not been well studied. This prospective study aimed to evaluate the incidence of bacteremia during the surgical procedure in patients with non-tubercular spondylodiscitis.

Methods

A single-center, prospective study was conducted from August 2019 to May 2020, enrolling 28 consecutive patients with biopsy-proven or MRI-suspected non-tuberculous vertebral osteomyelitis who underwent surgery. Preoperative blood, urine, and throat swab cultures were performed after a 48-hour antibiotic-free interval for patients who had been on prior antibiotics. Intraoperative venous blood cultures were collected immediately after disc preparation but before antibiotic administration. Surgical procedures included cervical discectomy/corpectomy, thoracic laminectomy with fixation, and lumbar Transforaminal Lumbar Interbody Fusion (TLIF). Culture results from blood, disc material, and other samples were analyzed.

Results

Intraoperative blood culture was positive in three patients (12.5%), with one patient showing the same organism preoperatively. Five patients had growth in disc material cultures; only one matched preoperative and perioperative blood cultures with methicillin-resistant Staphylococcus aureus (MRSA). Other samples showed variable pathogen growth without matching patterns. The overall intraoperative bacteremia rate was low, suggesting limited bloodstream entry during surgical manipulation.

Conclusion

Surgical manipulation of infected disc material in non-tubercular spondylodiscitis patients was not associated with a significant increase in bacteremia. However, a small sample size and only a few positive sample results are limitations of the study to conclude, and further multicentric studies with larger cohorts and multiple perioperative blood culture samples are warranted for more definitive conclusions.