Management of Asymptomatic Bacteriuria, Urinary Catheters and Symptomatic Urinary Tract Infections in Patients Undergoing Surgery for Joint Replacement: A Position Paper of the Expert Group 'Infection' of swissorthopaedics

Sendi, Parham; Borens, Olivier; Wahl, Peter; Clauss, Martin; Uçkay, İlker

doi:10.7150/jbji.20425

Cited by 14 publications

(6 citation statements)

References 44 publications

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“…7,31 Studies investigating the necessity of treating ASB before total joint arthroplasty have found no decrease in the risk of infection with such treatment. 9,32 In our study cohort, the fraction of patients receiving preoperative treatment for ASB was similar in the PVI and non-PVI groups (25% vs. 23.7%). However, the preoperative treatment protocol for ASB was neither mandatory nor randomized.…”

Section: Discussionmentioning

confidence: 72%

Investigation of preoperative asymptomatic bacteriuria as a risk factor for postvertebroplasty infection

Chen

Huang

Yao

et al. 2022

Journal of the Chinese Medical Association

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Vertebroplasty (VP) has gained in popularity as an effective treatment for painful osteoporotic vertebral fracture since its introduction by Galibert in 1987. 1 Although the procedure is generally safe and effective, catastrophic complications such as post-VP infection (PVI) occur at a rate of 0.32% to 0.46%. [2][3][4] Surgical management of PVI often requires an anterior approach to remove the cement, anterior fusion, and posterior instrumentation. This aggressive procedure is not well tolerated in aged and frail patients. The mortality rate of PVI is 10% to 33%. 2,3 With less than 60 cases reported to date, the potential risk factors for PVI remain elusive. 2 In primary vertebral osteomyelitis, hematogenous seeding from distant sites via the arterial route is the predominant pathway for pathogen infection of the vertebral column. Sites of infection that result in hematogenous spread include the respiratory tract, gastrointestinal tract, skin and soft tissue, and, most often, urinary tract infection (UTI). 5 Thus, VP is contraindicated in patients with active infection. 6 Asymptomatic bacteriuria (ASB), a condition that does not require treatment in most cases, 7 is another potential concern when considering VP. While ASB is found to be a risk factor for prosthetic joint infection, [8][9][10] the relationship between ASB and PVI is unknown.This study aims to investigate the incidence of ASB among patients who underwent VP to treat painful osteoporotic vertebral fractures, identify the risk factors for PVI, and determine whether ASB is a risk factor for PVI. METHODS Study design and populationThis study was approved by the institutional review board of our hospital (2020-02-013AC). A prospectively compiled database of patients who were admitted as VP candidates for the treatment of painful osteoporotic vertebral fractures between May 2015 and December 2019 was retrospectively analyzed to select the study cohort. Patients were excluded from the study

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Section: Discussionmentioning

confidence: 72%

Investigation of preoperative asymptomatic bacteriuria as a risk factor for postvertebroplasty infection

Chen

Huang

Yao

et al. 2022

Journal of the Chinese Medical Association

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“…At this time, the American Academy of Orthopedic Surgeons recommends preoperative urine testing prior to elective TJA, but they state that the evidence is weak regarding bacteriuria and negative outcomes 12) . Testing for and treating asymptomatic urinary colonization before orthopedic joint replacement surgery is likely unnecessary and may put the patient at additional risk 10 19 20) . In addition, treating ASB can be associated with adverse outcomes such as increased antibiotic resistance, adverse drug side effects, and unnecessary supply and personnel costs 9) .…”

Section: Discussionmentioning

confidence: 99%

Elimination of Routine Urinalysis before Elective Orthopaedic Surgery Reduces Antibiotic Utilization without Impacting Catheter-associated Urinary Tract Infection or Surgical Site Infection Rates

et al. 2021

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Purpose Routine preoperative urinalysis has been the standard of care for the orthopedic population for decades, regardless of symptoms. Studies have demonstrated antibiotic overuse and low concordance between bacteria cultured from the surgical wound and the urine. Testing and treatment of asymptomatic urinary tract colonization before total joint arthroplasty (TJA) is unnecessary and increases patient risk. We investigated reducing antibiotic use by (1) modifying testing algorithms to target patients at risk, (2) modifying reflex to culture criteria, and (3) providing treatment guidelines. Materials and Methods A pre-post study was conducted to determine identify the impact of eliminating universal urinalysis prior to TJA on surgical site infection (SSI) and catheter-associated urinary tract infection (CAUTI) rates and number of antibiotic prescriptions. Patients who underwent primary hip or knee TJA or spinal fusions from February 2016 to March 2018 were included. Patient data was collected for pre- and post-practice change period (February 2016-October 2016 and August 2017-March 2018). Patient demographics, urinalysis results, cultures, and prescriptions were analyzed retrospectively from every tenth chart in the pre-period and prospectively on all patients in the post-period. Results A total of 4,663 patients were studied. There was a 96% decrease in urinalyses performed ( P <0.0001), and a 93% reduction rate in antibiotic utilization ( P <0.001). No significant difference in SSI and CAUTI rates was observed ( P >0.05). Conclusion The elimination of routine urinalysis before orthopedic surgery resulted in a reduction in antibiotic utilization with no significant change in the SSI or CAUTI rates. Cost savings resulted from reduced antibiotic usage.

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“…Furthermore, some studies have found that bacteria causing prosthetic joint infection are not the same as those producing AB [ 128 , 129 ]. Therefore, most societies advocate not screening for or treating AB in these patients [ 1 , 21 ••, 41 , 130 ].…”

Section: Asymptomatic Bacteriuriamentioning

confidence: 99%

Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults

Hernández-Hernández

Padilla‐Fernández

Ortega-González

et al. 2021

Curr Bladder Dysfunct Rep

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Management of Asymptomatic Bacteriuria, Urinary Catheters and Symptomatic Urinary Tract Infections in Patients Undergoing Surgery for Joint Replacement: A Position Paper of the Expert Group 'Infection' of swissorthopaedics

Cited by 14 publications

References 44 publications

Investigation of preoperative asymptomatic bacteriuria as a risk factor for postvertebroplasty infection

Investigation of preoperative asymptomatic bacteriuria as a risk factor for postvertebroplasty infection

Elimination of Routine Urinalysis before Elective Orthopaedic Surgery Reduces Antibiotic Utilization without Impacting Catheter-associated Urinary Tract Infection or Surgical Site Infection Rates

Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults

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