Pre-operative screening for asymptomatic bacteriuria and associations with post-operative outcomes in patients with spinal cord injury

Abstract

Context: Screening for asymptomatic bacteriuria (ASB) before non-urologic surgery is common but of unclear benefit. Our aim was to describe pre-operative ASB screening and post-operative outcomes in patients with neurogenic bladder due to spinal cord injury (SCI).

Methods: This was a descriptive retrospective cohort study of adults with SCI undergoing neurosurgical spine or orthopedic lower limb surgery from 10/1/2012-9/30/2014 at Veterans Affairs (VA) medical centers. National VA datasets and medical record review was used to describe frequency of pre-operative ASB screening, presence of ASB, and association with post-operative surgical site infection, urinary tract infection, and hospital readmission.

Results: 175 patients were included. Although over half of patients had pre-operative ASB screening, only 30.8% actually had pre-operative ASB. 15.2% of patients screened were treated for ASB with antibiotics before surgery. Post-operative urinary tract infection (UTI) or surgical site infection (SSI) occurred in 10 (5.7%) patients, and 20 patients (11.4%) were readmitted within 30 days. Neither ASB screening nor the presence of pre-operative ASB were associated with these post-op outcomes (p > 0.2 for all).

Conclusion: Pre-operative ASB screening is common in patients with SCI undergoing elective spine and lower limb surgery, although ASB occurs in less than 1/3rd of cases. There were no associations between pre-operative ASB and outcomes. Further studies evaluating the clinical benefit of this practice in patients with SCI should be performed.

Keywords:

• Spinal cord injury
• Bacteriuria
• Urinary tract infection
• Orthopedic surgery
• Surgical site infection

Acknowledgements

This work was supported by Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service Postdoctoral Fellowship (TPR 42-005). The views expressed in this manuscript are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Disclosure statement

The authors have no relevant conflicts of interest to disclose. Portions of this work were presented as a poster at the Society for Healthcare Epidemiology of America Spring Conference 2017 on March 30, 2017 in St. Louis, MO and at the Academy for Spinal Cord Injury Professionals Conference and Expo on September 4, 2017 in Denver, CO.