Asymptomatic Bacteriuria and Periprosthetic Joint Infection Risk: A Systematic Review and Meta-Analysis

Periprosthetic joint infection (PJI) is a serious complication of hip and knee arthroplasty. Although hematogenous seeding is a recognized cause, the contribution of asymptomatic bacteriuria (ASB) remains uncertain. Therefore, we conducted a systematic review and meta-analysis to evaluate this association.

A systematic search was conducted according to predefined eligibility criteria. There were 16 studies (14 cohorts [n = 48,562 joints] and two randomized controlled trials [n = 1,065 joints] that met inclusion criteria. The primary outcome was PJI rates after hip and knee arthroplasties in patients who had ASB. The secondary outcomes were subgroup analyses by procedure type and culture isolates in urinary and intraoperative cultures. Random-effects meta-analyses used Mantel-Haenszel pooling with Hartung-Knapp-Sidik-Jonkman adjustments.

The ASB cohort showed higher pooled odds of PJI (odds ratio 2.41, 95% confidence interval 1.20 to 4.83; P = 0.02), but subgroup analyses by follow-up and procedure type were not significant. Antibiotic treatment offered no benefit in elective arthroplasty, and ASB in hip fracture hemiarthroplasty showed no increased risk, with or without antibiotics.

The ASB cohort demonstrated a statistically significant, yet modest, increased odds of PJI limited to pooled undifferentiated, arthroplasty. In contrast, procedure- and time-specific analyses, while underpowered, showed no consistent signal to suggest an increased risk of PJI following hip or knee arthroplasty or fracture hemiarthroplasty. Consistent with this, prophylactic antibiotic treatment of ASB was not associated with a protective effect. Taken together, these findings do not support routine preoperative urinalysis to promote antimicrobial stewardship.

Level II; systematic review and meta-analysis of Level I through III studies.