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Multicenter Study
. 2014 Jul 1;59(1):41-7.
doi: 10.1093/cid/ciu235. Epub 2014 Apr 9.

Is asymptomatic bacteriuria a risk factor for prosthetic joint infection?

Ricardo Sousa  1 , Ernesto Muñoz-Mahamud  2 , Jonathan Quayle  3 , Luis Dias da Costa  1 , Cristina Casals  2 , Phylip Scott  3 , Pedro Leite  1 , Paz Vilanova  2 , Sebastian Garcia  2 , Maria Helena Ramos  4 , Joana Dias  5 , Alex Soriano  6 , Andrea Guyot  7
Affiliations
Multicenter Study

Is asymptomatic bacteriuria a risk factor for prosthetic joint infection?

Ricardo Sousa et al. Clin Infect Dis. .

Abstract

Background: Infection is a major complication after total joint arthroplasty. The urinary tract is a possible source of surgical site contamination, but the role of asymptomatic bacteriuria (ASB) before elective surgery and the subsequent risk of infection is poorly understood.

Methods: Candidates for total hip or total knee arthroplasty were reviewed in a multicenter cohort study. A urine sample was cultured in all patients, and those with ASB were identified. Preoperative antibiotic treatment was decided on an individual basis, and it was not mandatory or randomized. The primary outcome was prosthetic joint infection (PJI) in the first postoperative year.

Results: A total of 2497 patients were enrolled. The prevalence of ASB was 12.1% (303 of 2497), 16.3% in women and 5.0% in men (odds ratio, 3.67; 95% confidence interval, 2.65-5.09; P < .001). The overall PJI rate was 1.7%. The infection rate was significantly higher in the ASB group than in the non-ASB group (4.3% vs 1.4%; odds ratio, 3.23; 95% confidence interval, 1.67-6.27; P = .001). In the ASB group, there was no significant difference in PJI rate between treated (3.9%) and untreated (4.7%) patients. The ASB group had a significantly higher proportion of PJI due to gram-negative microorganisms than the non-ASB group, but these did not correlate to isolates from urine cultures.

Conclusions: ASB was an independent risk factor for PJI, particularly that due to gram-negative microorganisms. Preoperative antibiotic treatment did not show any benefit and cannot be recommended.

Keywords: bacteriuria; incidence; prosthesis-related infections; risk factors.

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