Risk of Surgical Site Infection in Patients with Asymptomatic Bacteriuria or Abnormal Urinalysis before Joint Arthroplasty: Systematic Review and Meta-Analysis

Systematic review and meta‐analysis of asymptomatic bacteriuria after renal transplantation: incidence, risk of complications, and treatment outcomes

“…Also, the fact that clinical signs of UTI can be significantly masked because of the effect of immunosuppressive therapies and the graft denervation have positioned the treatment of post‐transplant ASB as a paradigm across history . However, recent evidence has advocated for changes in this practice, as high‐level studies are showing the lack of benefit that antimicrobial therapy can confer in populations with a similar treatment paradigm (joint arthroplasty and pregnant women, among others) . Specifically, a systematic review and meta‐analysis discussed the benefit of prophylaxis for UTI/ASB in patients after KT, showing a lower risk of sepsis with bacteremia (RR 0.13, 95% CI 0.02‐0.7) and bacteriuria (RR 0.41, 95% CI 0.31‐0.56) with prophylaxis; however, there was no evidence of a reduction in all‐cause mortality, graft loss, or adverse events rates .…”

“…29 However, recent evidence has advocated for changes in this practice, as high-level studies are showing the lack of benefit that antimicrobial therapy can confer in populations with a similar treatment paradigm (joint arthroplasty and pregnant women, among others). 30,31 Specifically, a systematic review and meta-analysis discussed the benefit of prophylaxis for UTI/ASB in patients after KT, showing a lower risk of sepsis with bacteremia (RR 0.13, 95% CI 0.02-0.7) and bacteriuria (RR 0.41, 95% CI 0.31-0.56) with prophylaxis; however, there was no evidence of a reduction in all-cause mortality, graft loss, or adverse events rates. 32 In contrast, a recent Cochrane review aimed to evaluate the utility of antibiotic therapy for treating ASB episodes regarding a vast number of adverse outcomes.…”

Preoperative optimization to prevent periprosthetic joint infection in at-risk patients

“…80 A meta-analysis by Gomez-Ochoa included more than 2000 total joint arthroplasty patients in 11 studies found no difference in the PJI rate between treated and untreated bacteriuria. 81 Hence, there is limited evidence to support preoperative screening and treatment of asymptomatic bacteriuria.…”

Asymptomatic Bacteriuria: For How Long Will We Keep Swimming Against The Current?

“…This study adds valuable information to the existing literature and is in accordance with the conclusions of most of the studies and guidelines published until now. [7][8][9][10][11] Since 2005, several studies have shown the lack of benefit of systematic screening and antimicrobial treatment of ASB in populations different from pregnant women. 9,10,12,13 Moreover, multiple scientific entities, such as the Infectious Diseases Society of America (IDSA) and the US Preventive Services Task Force (USPSTF), have published clinical guidelines addressing the issue of ASB management, all concluding that treatment could be justified only in gravid women.…”

“…[7][8][9][10][11] Since 2005, several studies have shown the lack of benefit of systematic screening and antimicrobial treatment of ASB in populations different from pregnant women. 9,10,12,13 Moreover, multiple scientific entities, such as the Infectious Diseases Society of America (IDSA) and the US Preventive Services Task Force (USPSTF), have published clinical guidelines addressing the issue of ASB management, all concluding that treatment could be justified only in gravid women. 8,11 Then, it is reasonable to ask ourselves: after more than ten years of existing literature that discourages systematic screening and treatment for ASB, why do we keep seeing studies evaluating ASB screening and treatment published in medical journals and with this high relevance?…”