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

Abstract

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.

Candida periprosthetic joint infection: A rare and difficult-to-treat infection

“…These data suggest that searching and treating candidal intertrigo before hip surgery could be a simple, safe, and inexpensive measure to avoid CPJI. The approach to take in candiduria would be less clear-cut when there are no symptoms, as occurs with asymptomatic bacteriuria [21,22]. It has been reported that hematogenous seeding of a prosthetic joint is a common complication of Staphylococcus aureus bacteremia [23], but to our knowledge, the risk of developing CPJI after experiencing candidemia is unknown.…”

The necessity of treating asymptomatic bacteriuria with antibiotics in the perioperative period of joint arthroplasty: a metaanalysis

“…No literature was found through manual search, duplicated articles were removed, and articles that did not meet the inclusion criteria also were removed. A total of articles were read in detail, were removed, and 9 were finally included [8][9][10][11][17][18][19][20][21]. There were 29844 cases of joint replacement and 2366 cases of asymptomatic bacteriuria, among which 6 were retrospective cohort studies, 1 was a prospective cohort study, and 2 were prospective randomized controlled studies, as shown in the literature screening process Figure 1.…”

“…The results showed that compared with the control group, patients with asymptomatic bacteriuria during the perioperative period of joint replacement were more likely to suffer from periprosthetic infection with a significant difference (OR=3.15, 95% CI: 1.23-8.02, P=0.02), as shown in Figure 2. After removing the article of Honkanen et al [9], heterogeneity decreased: I 2 =42%, P=0.12, there was moderate heterogeneity, which was demonstrated by the fixed effect model; the difference between the two groups was still significant (OR=3.81, 95% CI: 2.46-5.91, P < 0.000 01). See Figure…”

“…The relationship between asymptomatic bacteriuria during the perioperative period of joint replacement and postoperative periprosthetic infection was included in 9 studies [8][9][10][11][17][18][19][20][21]. All outcomes included the statistics of postoperative infection rate around the joint prosthesis, and the results of heterogeneity test were: l 2 =78%，P=0.000 2, It was suggested that there was a high degree of heterogeneity in the included studies, so the random effect model was used to merge the statistics.…”

“…However, whether asymptomatic bacteriuria can cause artificial joint infection remains to be confirmed. Some scholars reported that asymptomatic bacteriuria did not affect the incidence of periarticular infection after joint replacement, and even if bacterial infections around periprosthetic infections are present, they are different from urinary tract infections [7][8][9]; others reported that asymptomatic bacteriuria increased the incidence of postoperative periarticular prosthesis infection but only in retrospective studies where the quality of evidence was low [10,11]. At present, different guidelines are also contradictory: The British Orthopaedic Association guidelines [12] support routine pre-operative urine screening, but do not indicate whether treatment is required; the Scottish Intercollegiate Guidelines Network [13] states that patients should not be treated with antibiotics for asymptomatic bacteriuria unless pregnant.…”