Risk factors associated with low-grade virulent infection in intervertebral disc degeneration: a systematic review and meta-analysis

Abstract

Background

An increasing number of research indicates an association between low-grade bacterial infections, particularly those caused by Propionibacterium acnes (P. acnes), and the development of intervertebral disc degeneration (IDD). However, no previous meta-analysis has systematically assessed the risk factors for low-grade bacterial infections that cause IDD.

Purpose

This study reviewed the literature to evaluate the risk factors associated with low-grade bacterial infection in patients with IDD.

Study design

Systematic review and meta-analysis

Methods

The systematic literature review was conducted using the PubMed, Web of Science, Embase, and Cochrane Library databases. Eligible articles explicitly identified the risk factors for low-grade bacterial infections in IDD patients. Patient demographics and total bacterial infection rates were extracted from each study. Meta-analysis was performed using random- or fixed-effects models, with statistical analyses conducted using Review Manager (RevMan) 5.4 software.aut

Results

Thirty-three studies involving 4109 patients were included in the meta-analysis. The overall pooled low-grade bacterial infection rate was 30% (range, 24–37%), with P. acnes accounting for 25% (range, 19–31%). P. acnes constituted 66.7% of bacteria-positive discs. Fourteen risk factors were identified, of which eight were quantitatively explored. Strong evidence supported male sex (odds ratio [OR]=2.15; 95% confidence interval [CI]=1.65–2.79; P<0.00001) and Modic changes (MCs) (OR=3.59; 95% CI=1.68–7.76; P=0.0009); moderate evidence of sciatica (OR=2.31; 95% CI=1.33–4.00; P=0.003) and younger age (OR=-3.47; 95% CI=-6.42 to -0.53; P=0.02). No evidence supported previous disc surgery, MC type, Pfirrmann grade, smoking, or diabetes being risk factors for low-grade bacterial infections in patients with IDD.

Conclusions

Current evidence highlights a significant association between IDD and low-grade bacterial infections, predominantly P. acnes being the most common causative agent. Risk factors associated with low-grade bacterial infections in IDD include male sex, MCs, sciatica, and younger age.