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Published on: February 2, 2024
Asymptomatic Bacteriuria and Periprosthetic Joint Infection Risk: A Systematic Review and Meta-Analysis
V Roy1, A Van Brenk2, L R Benaroch1
1Schulich School of Medicine & Dentistry, Department of Orthopaedic Surgery, University of Western Ontario, London, Canada.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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 Of Evidence:
Level II; systematic review and meta-analysis of Level I through III studies.
Insights
Asymptomatic bacteriuria (ASB) shows a modest increased risk for periprosthetic joint infection (PJI) after undifferentiated arthroplasty. However, ASB does not appear to increase PJI risk for specific procedures like hip or knee arthroplasty.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Public Health
Background:
- Periprosthetic joint infection (PJI) is a significant complication following hip and knee arthroplasty.
- The role of asymptomatic bacteriuria (ASB) in causing PJI is not well-established.
Purpose of the Study:
- To systematically review and meta-analyze the association between asymptomatic bacteriuria and periprosthetic joint infection risk.
Main Methods:
- A systematic search identified 16 studies (14 cohort, 2 RCTs) including over 49,000 joints.
- Meta-analyses assessed PJI rates in patients with ASB, with subgroup analyses by procedure type and culture isolates.
- Random-effects models with specific adjustments were employed.
Main Results:
- Asymptomatic bacteriuria was associated with a statistically significant, albeit modest, increased odds of PJI in pooled undifferentiated arthroplasty data (OR 2.41).
- Subgroup analyses by follow-up and procedure type did not yield significant results.
- Antibiotic treatment showed no benefit for elective arthroplasty, and ASB posed no increased risk in hip fracture hemiarthroplasty.
Conclusions:
- The findings suggest a modest increased risk of PJI associated with ASB in general arthroplasty, but not consistently for specific procedures.
- Prophylactic antibiotics for ASB did not demonstrate a protective effect against PJI.
- Routine preoperative urinalysis is not supported for antimicrobial stewardship in arthroplasty patients.
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