Escherichia coli vertebral osteomyelitis and spondylodiscitis following transurethral lithotripsy: a delayed complication possibly associated with untreated asymptomatic bacteriuria - a case report

Abstract

Vertebral osteomyelitis and spondylodiscitis are uncommon infections, most frequently caused by Staphylococcus aureus. Gram-negative organisms such as Escherichia coli are rare etiologic agents and are usually associated with a urinary tract source. We report a case of E. coli vertebral osteomyelitis and spondylodiscitis with abscess formation in a 66-year-old man occurring 6 months after transurethral lithotripsy (TUL). The patient had evidence of preoperative pyuria suggestive of asymptomatic bacteriuria that was not definitively treated. No prophylactic or postoperative antibiotics were administered. The patient denied any intercurrent illness or alternative source of bacteremia. MRI and CT-guided biopsy were revealed vertebral osteomyelitis and spondylodiscitis at T9-T10 with a small paravertebral abscess. CT-guided biopsy of the vertebral lesion grew E. coli with the same susceptibility profile as the preoperative urine isolate: resistant to ciprofloxacin and ceftriaxone but susceptible to cefepime. The patient received intravenous cefepime for six weeks. He improved substantially within two weeks and was pain-free with normalized inflammatory markers and complete radiological resolution by the end of treatment. Follow-up at 12 months showed no recurrence. This case illustrates that untreated asymptomatic bacteriuria may rarely be associated with delayed hematogenous vertebral infection following urologic instrumentation. It underscores the importance of screening and treating bacteriuria before procedures that breach the urinary mucosa, in accordance with current guideline recommendations.