Prevalence of asymptomatic bacteriuria in knee arthroplasty patients and subsequent risk of prosthesis infection

Martínez-Vélez, David; González-Fernández, Enrique; Esteban, Jaime; Cordero‐Ampuero, José

doi:10.1007/s00590-015-1720-4

Cited by 30 publications

(24 citation statements)

References 23 publications

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“…The prevalence of preoperative bacteriuria was 6.8%, which is similar to two earlier Spanish studies [12,15] and slightly lower than in other studies [8,13,14]. There was no association between preoperative bacteriuria and postoperative surgical site infection or PJI.…”

Section: Discussionsupporting

confidence: 84%

“…In a more recent study, Cordero-Ampuero et al [12] found no association between preoperative bacteriuria and postoperative infection following hip replacement, and treating the bacteriuria with antibiotics had no effect on the incidence of infection. The same research group reported similar results for knee replacements [15]. Unlike earlier studies, the current study takes into account the effect of both chronic diseases and outpatient antibiotic use.…”

Section: Discussionsupporting

confidence: 53%

“…It has been estimated that to conduct a reliable prospective randomized controlled trial that compares the screening and treatment of bacteriuria with no screening and treatment, it would require a study population of 50 000 patients in each study arm, which is not feasible [13]. Previous prospective studies [11,12,14,15] have had small sample sizes, and so have been insufficiently powered.…”

Section: Discussionmentioning

confidence: 99%

“…Some of these studies have shown an increased risk of postoperative infection complications in patients with preoperative ASB [11,14], but direct seeding to the prosthetic joint has not been reported. Furthermore, treating preoperative ASB with antibiotics has not been shown to be effective in preventing PJI [7,12,14,15].…”

Section: Introductionmentioning

confidence: 99%

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The impact of preoperative bacteriuria on the risk of periprosthetic joint infection after primary knee or hip replacement: a retrospective study with a 1-year follow up

Honkanen

Jämsen

Karppelin

et al. 2018

Clinical Microbiology and Infection

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Objectives: Patients who undergo elective joint replacement are traditionally screened and treated for preoperative bacteriuria to prevent periprosthetic joint infection (PJI). More recently, this practice has been questioned. The purpose of this study was to determine whether preoperative bacteriuria is associated with an increased risk of PJI. Methods: Patients who had undergone a primary hip or knee replacement in a tertiary care hospital between September 2002 and December 2013 were identified from the hospital database (23 171 joint replacements, 10 200 hips, and 12 971 knees). The results of urine cultures taken within 90 days before the operation were obtained. Patients with subsequent PJI or superficial wound infection in a 1-year follow-up period were identified based on prospective infection surveillance. The association between bacteriuria and PJI was examined using a multivariable logistic regression model that included information on the operated joint, age, gender and the patients' chronic diseases. Results: The incidence of PJI was 0.68% (n ¼ 158). Preoperative bacteriuria was not associated with an increased risk of PJI either in the univariate (0.51% versus 0.71%, OR 0.72, 95% CI 0.34e1.54) or in the multivariable (OR 0.82, 95% CI 0.38e1.77) analysis. There were no cases where PJI was caused by a pathogen identified in the preoperative urine culture. Results were similar for superficial infections. Conclusions: There was no association between preoperative bacteriuria and postoperative surgical site infection. Based on these results, it seems that the preoperative screening and treatment of asymptomatic bacteriuria is not required.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The impact of preoperative bacteriuria on the risk of periprosthetic joint infection after primary knee or hip replacement: a retrospective study with a 1-year follow up

Honkanen

Jämsen

Karppelin

et al. 2018

Clinical Microbiology and Infection

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show abstract

“…[9][10][11][12][13] However, there remains a lack of good evidence that treating asymptomatic bacteriuria reduces the risk of subsequent prosthetic joint infection. Published studies are all small, with insufficient power to generate convincing results.…”

Section: Association Not Causationmentioning

confidence: 99%

Screening for asymptomatic bacteriuria before total joint arthroplasty

Mayne

Davies

Simpson

2016

BMJ

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Association of Screening and Treatment for Preoperative Asymptomatic Bacteriuria With Postoperative Outcomes Among US Veterans

Salazar

O’Brien²,

Strymish

et al. 2019

JAMA Surg

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IMPORTANCE Limited data suggest that screening for asymptomatic bacteriuria (ASB) prior to nonurologic procedures is not useful. However, high-quality evidence to support consensus recommendations and influence clinical practice is lacking. OBJECTIVE To characterize the association between detection and treatment of preoperative ASB and postoperative outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study involved patients, predominantly male veterans, who underwent surgical procedures in 109 US facilities within the US Department of Veterans Affairs health care system from October 1, 2008, to September 30, 2013. Participants included patients (n = 68 265) who had cardiac, orthopedic, or vascular surgical procedures. Each received a planned clinician review of complete medical records for antimicrobial prophylaxis as well as 30-day surgical-site infection (SSI) and urinary tract infection (UTI) outcomes, and each had a preoperative urine culture result available within the 30 days prior to the procedure. Data analysis was performed from December 2016 to August 2018. MAIN OUTCOME AND MEASURES The primary outcome was the association between preoperative ASB and postoperative SSI. The secondary outcomes included postoperative UTI and the association between antimicrobial therapy for ASB and postoperative infectious outcomes. RESULTS In total, 68 265 patients (65 664 [96.2%] were men and 2601 [3.8%] were women, with a mean [SD] age of 64.6 [9.2] years) were identified, and 17 611 (25.8%) were eligible for inclusion in the primary analysis. Preoperative urine cultures were performed in 17 749 (26.0%) patients, and the results were positive in 755 (4.3%), of which 617 (81.7%) were classified as ASB. With adjustments for age, American Society of Anesthesiologists class, smoking status, race/ethnicity, sex, and diabetes status, patients with or without ASB had similar odds of SSI (2.4% vs 1.6%; adjusted odds ratio [aOR], 1.58; 95% CI, 0.93-2.70; P = .08). Receipt of antimicrobial therapy with activity against the ASB organism was not associated with a reduced SSI risk (aOR, 1.01; 95% CI, 0.28-3.65; P = .99). Urinary tract infection occurred in 14 (3.3%) of 423 patients with ASB and 196 (1.5%) of 12 913 patients without ASB (aOR, 1.42; 95% CI, 0.80-2.49; P = .22). Treatment or prophylaxis for the ASB organism similarly was not associated with reduced odds of postoperative UTI (aOR 0.68; 95% CI, 0.20-2.30; P = .54). The ASB organisms matched a postoperative wound culture in 2 cases, both Staphylococcus aureus. CONCLUSIONS AND RELEVANCE The findings of this study suggest that receipt of antimicrobial therapy with activity against ASB organisms identified in preoperative urine cultures was not associated with reductions in the risk for postoperative infections, including UTI and SSI; such findings suggest there is evidence for discontinuing the practice of screening and treatment for preoperative ASB.

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Prevalence of asymptomatic bacteriuria in knee arthroplasty patients and subsequent risk of prosthesis infection

Abstract: Asymptomatic bacteriuria presents a low prevalence. We have not found any case of arthroplasty infection from urinary focus in patients with asymptomatic bacteriuria whether they received or not specific antibiotics.

Cited by 30 publications

References 23 publications

The impact of preoperative bacteriuria on the risk of periprosthetic joint infection after primary knee or hip replacement: a retrospective study with a 1-year follow up

The impact of preoperative bacteriuria on the risk of periprosthetic joint infection after primary knee or hip replacement: a retrospective study with a 1-year follow up

Screening for asymptomatic bacteriuria before total joint arthroplasty

Association of Screening and Treatment for Preoperative Asymptomatic Bacteriuria With Postoperative Outcomes Among US Veterans

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