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Is asymptomatic bacteriuria a risk factor for prosthetic joint infection?
Ricardo Sousa1, Ernesto Muñoz-Mahamud2, Jonathan Quayle3
1Departments of Orthopaedics.
Summary
Asymptomatic bacteriuria (ASB) significantly increases the risk of prosthetic joint infection (PJI) after joint replacement surgery. Preoperative antibiotics for ASB did not reduce PJI rates, suggesting current treatment approaches may be ineffective.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Urology
Background:
- Infection is a significant complication following total joint arthroplasty (TJA).
- The urinary tract is a potential source of surgical site contamination.
- The association between asymptomatic bacteriuria (ASB) and prosthetic joint infection (PJI) risk is not well understood.
Purpose of the Study:
- To investigate the association between preoperative asymptomatic bacteriuria (ASB) and the risk of prosthetic joint infection (PJI) after total hip or knee arthroplasty.
- To evaluate the efficacy of preoperative antibiotic treatment in patients with ASB undergoing elective joint replacement.
Main Methods:
- A multicenter cohort study involving patients undergoing total hip or knee arthroplasty.
- Urine cultures were performed preoperatively to identify asymptomatic bacteriuria (ASB).
- Prosthetic joint infection (PJI) rates were monitored for one year postoperatively; antibiotic treatment decisions were made individually.
Main Results:
- The prevalence of ASB was 12.1%, higher in women than men.
- Patients with ASB had a significantly higher risk of PJI (4.3% vs 1.4%).
- Preoperative antibiotic treatment in the ASB group did not significantly alter the PJI rate (3.9% vs 4.7%).
Conclusions:
- Asymptomatic bacteriuria (ASB) is an independent risk factor for prosthetic joint infection (PJI), especially those caused by gram-negative microorganisms.
- Preoperative antibiotic treatment for ASB before elective joint arthroplasty showed no benefit in preventing PJI.
- Current recommendations for antibiotic treatment of ASB prior to joint replacement surgery may need reevaluation.
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