Are Antibiotics Necessary in Hip Arthroplasty With Asymptomatic Bacteriuria? Seeding Risk With/Without Treatment

Abstract

Background In patients with asymptomatic bacteriuria undergoing hip arthroplasty, the risk of prosthetic joint infection (PJI) and appropriateness of specific antibiotics are unclear. Questions/purposes We determined (1) the prevalence of asymptomatic bacteriuria; and (2) the incidence of PJI in patients with asymptomatic bacteriuria managed with or without specific antibiotics.

Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

“…In a recent prospective randomized study including 471 patients, ASB occurred in 8 (3.5%) of 228 patients undergoing total hip arthroplasty and in 38 (15.6%) of 243 patients undergoing hemiarthroplasty. 69 Patients were randomized to receive specific antibiotic treatment or no treatment. No case of prosthetic joint infection from urinary origin was identified in any study group in this trial.…”

Risk factors for periprosthetic joint infection following total hip and knee arthroplasty

“…According to Cordero-Ampuero J et al, the risk for periprosthetic joint infection in patients with asymptomatic bacteriuria is negligible so there is no need for prophylactic antibiotic therapy 26 . Among 228 patients who submitted total hip replacement, 8 persons had asymptomatic bacteriuria diagnosed from urine cultures 26 .…”

“…According to Cordero-Ampuero J et al, the risk for periprosthetic joint infection in patients with asymptomatic bacteriuria is negligible so there is no need for prophylactic antibiotic therapy 26 . Among 228 patients who submitted total hip replacement, 8 persons had asymptomatic bacteriuria diagnosed from urine cultures 26 . Only one person developed periprosthetic joint infection, but cultures from the surgical site showed different pathogens between the joint and urinary tract 26 .…”

Screening for asymptomatic bacteriuria before total joint arthroplasty

“…[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.…”

“…8 Of note, the pathogens isolated as a cause of deep prosthetic joint infection are generally different from those detected in the urine of asymptomatic patients preoperatively. 15 This suggests that asymptomatic bacteriuria is not a direct cause of prosthetic joint infection. It may instead be an indicator of reduced immune function and increased susceptibility to infection.…”