Lower Urinary Tract Infection and Periprosthetic Joint Infection after Elective Primary Total Hip Arthroplasty

Park, Chan Ho; Lee, Youngkyun; Koo, Kyung‐Hoi

doi:10.5371/hp.2017.29.1.30

Cited by 17 publications

(7 citation statements)

References 30 publications

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“…Treatment of ASB detected on routine pre-operative urine cultures was responsible for 10/176 (5.7%) of inpatient antimicrobial prescriptions in the pre-survey, and 4/192 (2.1%) of inpatient antimicrobial prescriptions in the post-survey (-3.6%, p = 0.071). This treatment is not associated with reduction in operative infections after prosthetic joint surgery and is inappropriate [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John’s, Canada

et al. 2021

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Objectives Inappropriate antibiotic use contributes to antimicrobial resistance. The SpectrumTM app provides antibiotic decision support, based on local antimicrobial resistance rates. We determined the impact of regional implementation of the app on inpatient antimicrobial appropriateness, inpatient antimicrobial usage (AMU), population-based Clostridioides difficile infection (CDI) rates and cost, using a retrospective, before and after quasi-experimental design, including a one-year study period. Methods The SpectrumTM app was released to prescribers in February, 2019. We performed two one-day inpatient point prevalence surveys using the National Antimicrobial Prescribing Survey tool, six months before (June 25, 2018) and six months after (June 25, 2019) app dissemination. Inpatient AMU in Defined Daily Dose/1000 patient days and CDI incidence were compared, before and after app dissemination. Results The pre-survey included 184 prescriptions, and the post-survey included 197 prescriptions. Appropriateness was 97/176 (55.1%) pre, and 126/192 (65.6%) post (+10.5%, p = 0.051). Inpatient AMU declined by 6.6 DDD/1000 patient days per month, and CDI declined by 0.3 cases per month. Cost savings associated with reduced AMU were $403.98/bed/year and associated with reduced CDI were $82,078/year. Conclusion We observed improvement in antimicrobial stewardship indicators following SpectrumTM implementation. We cannot determine the cause of these improvements.

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Section: Discussionmentioning

confidence: 99%

Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John’s, Canada

et al. 2021

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“…On the other hand, Park et al 6) compared the incidence of PJI in a UTI group (13 patients) and non-UTI group (514 patients), and observed no significant association between preoperatively treated UTI and PJI. They treated UTI patients with antibiotics before THA if the urine culture was positive.…”

Section: Preoperative Symptomatic Urinary Tract Infectionmentioning

confidence: 99%

“…A diagnosis of urinary tract infection (UTI) is made when more than 10 5 CFU/mL is observed in urine culture 1) . Women are significantly more prone to UTIs than men; the reported prevalence of preoperative UTI in female patients undergoing total joint arthroplasty (TJA) ranges from 5.1% to 36% 2 3 4 5 6 7) .…”

Section: Introductionmentioning

confidence: 99%

“…We reviewed articles highlighting the relationship between UTIs and PJI, and summarized recommendations of an international consensus on orthopedic infections, an event which was held in July 2018 in Philadelphia. We separately described symptomatic UTI and ASB, because their causative effects on PJI are quite different 3 4 6 7 11 12) .…”

Section: Introductionmentioning

confidence: 99%

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Should a Urinary Tract Infection Be Treated before a Total Joint Arthroplasty?

Parvızı

Koo

2019

Hip & Pelvis

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Periprosthetic joint infection (PJI) is one of the most serious complications after total joint arthroplasty (TJA). The prevalence of urinary tract infection (UTI) is common, particularly among elderly women, a group for whom TJA may be required. The association between preoperative UTI and increased risk of PJI after TJA is unclear. We reviewed key articles concerning the relationship between UTIs and PJI, and summarized recommendations of international consensus on PJI, which was established in Philadelphia in July of 2018. In addition, we distinguish between symptomatic UTI and asymptomatic bacteriuria, because their causative effects on PJI are quite different.

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“…An enlarged prostate may compress the urethra and cause anatomic bladder outlet obstruction, which may predispose patients to urinary retention requiring catheterization, urinary tract infection (UTI), and urosepsis [2,18]. UTI-associated organisms may then seed the implant via transient bacteremia, although this association is controversial [10,15,16,19]. As PJI is associated with high morbidity, such as persistent joint pain and function [22], and it is one of the leading causes of revision THA [9], exploring the association between sBPH and medical and implant-related complications may be beneficial in assessing whether perioperative assessment and management of patients with sBPH should be changed to improve surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Symptomatic Benign Prostatic Hyperplasia Is Not Associated With a Higher Risk of Periprosthetic Joint Infections and Periprosthetic Joint Infection–related Revisions After Primary THA

Jeong

Lee

Boucher

2023

Clin Orthop Relat Res

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Background Symptomatic benign prostatic hyperplasia (sBPH) is a potential risk factor for periprosthetic joint infection (PJI), a leading cause of implant failure and revision THA. However, the available evidence is mixed on whether this is the case. Questions/purposes (1) What is the prevalence of sBPH in male recipients of primary THA by age group? (2) Do patients with sBPH compared with those without sBPH have higher 30-day, 90-day, and 2-year odds of PJI and higher 30-day and 90-day odds of urinary catheterization, urinary tract infection (UTI), and sepsis after primary THA? (3) Do patients with sBPH compared with those without sBPH have lower survivorship free from PJI-related revision at 5 years after THA? Methods The PearlDiver database was used as it provided the largest sample of patients across all payer types to perform longitudinal research. Between January 2010 and April 2021, 1,056,119 patients who underwent primary THA were identified. After applying the inclusion criteria (that is, male sex, minimum age of 18, and diagnosis of hip osteoarthritis) and exclusion criteria (that is, history of asymptomatic BPH or any other joint arthroplasty), 16% (172,866) of patients remained. A further 6% (59,500) of patients were excluded as they did not meet the minimum study follow-up of 2 years, leaving 11% (113,366) for analysis. Of those, patients with sBPH were matched to those without in a 1:4 ratio by age and comorbidities, including alcohol abuse, anemia, cardiovascular disorders, chronic pulmonary disease, diabetes mellitus, depression, obesity, peripheral vascular disorders, renal failure, and rheumatoid arthritis. Age and comorbidities of the two groups postmatch were balanced. Logistic regression was performed to analyze the odds for 30-day, 90-day, and 2-year postoperative complications. Survivorship free from PJI-related revision at 5 years after THA was estimated using the Kaplan-Meier method and compared with the log-rank test. Results Among male recipients of primary THA ages 65 or older, 24% (11,319 of 47,426) had a medical history of sBPH. We found no difference in the odds of PJI at 30 days, 90 days, and 2 years after primary THA between the two groups. PJI occurred in 0.5% (62 of 11,819), 0.8% (97 of 11,819), and 1.3% (150 of 11,819) of patients with sBPH versus in 0.5% (227 of 47,103), 0.8% (360 of 47,103), and 1.2% (570 of 47,103) of those without sBPH within 30 days (OR 1.09 [95% CI 0.82 to 1.43]), 90 days (OR 1.07 [95% CI 0.85 to 1.34]), and 2 years (OR 1.05 [95% CI 0.87 to 1.25]) after THA, respectively. Patients with sBPH compared with those without had higher odds of 30-day and 90-day urinary catheterization (OR 5.00 [95% CI 3.64 to 6.88] and OR 5.36 [95% CI 4.04 to 7.13], respectively), 30-day and 90-day UTI (OR 2.18 [95% CI 1.88 to 2.54] and OR 2.55 [95% CI 2.26 to 2.87], respectively), and 30-day and 90-day sepsis (OR 1.55 [95% CI 1.11 to 2.13] and OR 1.43 [95% CI 1.10 to 1.83], respectively). We found no difference in survival free from PJI-related revision at 5 years after THA between patients with and without sBPH (98.3% [95% CI 98.1% to 98.6%] versus 98.1% [95% CI 98.1% to 98.2%]; p = 0.10). Conclusion sBPH is common among THA recipients, and surgeons should be aware of the added risk of postoperative urinary complications and sepsis in this subset that could lead to additional postoperative care requirements. Surgeons may consider perioperative measures such as preoperative use of short-form questionnaires to assess urinary symptoms, urology clearance or referral, and closer follow-up to improve care of sBPH patients undergoing THA. As currently available tools for assessing sBPH are limited and lack sensitivity as well as specificity, future studies may develop validated tools that can be used to quickly assess risk in sBPH patients before surgery. Level of Evidence Level III, therapeutic study.

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Lower Urinary Tract Infection and Periprosthetic Joint Infection after Elective Primary Total Hip Arthroplasty

Cited by 17 publications

References 30 publications

Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John’s, Canada

Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John’s, Canada

Should a Urinary Tract Infection Be Treated before a Total Joint Arthroplasty?

Symptomatic Benign Prostatic Hyperplasia Is Not Associated With a Higher Risk of Periprosthetic Joint Infections and Periprosthetic Joint Infection–related Revisions After Primary THA

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