Should an asymptomatic patient with an abnormal urinalysis (bacteriuria or pyuria) be treated with antibiotics prior to major joint replacement surgery?

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

“…Prevalence is reported from 8% to 28% [10]. It is unclear whether it is important to detect preoperative asymptomatic bacteriuria as well as the best approach for that [8,23]. Furthermore, the appropriateness of treating patients undergoing hip arthroplasty with asymptomatic bacteriuria is unclear.…”

“…A related but absolutely different clinical situation, asymptomatic bacteriuria, presents an increasing prevalence with age and female sex, from 1% among schoolgirls to [ 40% among women older than 80 years [4,11,14,18,19]. There are four papers about preoperative asymptomatic bacteriuria in patients undergoing hip arthroplasty [8,10,20,23]. Prevalence is reported from 8% to 28% [10].…”

“…Several papers describe preoperative asymptomatic bacteriuria in patients undergoing hip arthroplasty [8,10,20,23]. Glynn and Sheehan [10] found a prevalence of 28% in female and 8% in male patients undergoing hip or knee arthroplasty.…”

“…David and Vrahas [8] proposed pyuria (more than 1000 white blood cells/mL in urinalysis) as a preliminary screening criterion for urine culture. Rajamanickam et al [23] recommended performing a urinalysis before hip arthroplasty only when a urinary catheter was anticipated postoperatively, then obtaining a urine culture if urinalysis was abnormal. Furthermore, the appropriateness of treating patients undergoing hip arthroplasty with asymptomatic bacteriuria is unclear.…”

“…Glynn and Sheehan [10] reported pre-, intra-, and/or postoperative treatment with a specific antibiotic according to the sensitivity of the cultured organisms, but they did not postpone surgery in their asymptomatic patients. The reviews (expert opinions with Level V of Evidence) [8,20,23] recommend to proceed with total joint arthroplasty and treating those patients with asymptomatic bacteriuria with an 8-to 10-day postoperative course of an appropriate oral antibiotic [8], with perioperative specific antibiotics [23], or with cefuroxime if preoperative pyuria is detected [20] . Other papers [18,19] provide general recommendations for either treating or not treating asymptomatic patients with bacteriuria, but not in patients who will undergo hip arthroplasty.…”