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Urinary tract infection and hip fracture
D J Johnstone1, N H Morgan, M C Wilkinson
1Department of Orthopaedic Surgery, Charing Cross Hospital, London, UK.
Injury
|March 1, 1995
Summary
Urinary tract infections (UTIs) complicate proximal femoral fractures, especially in females with intra-capsular fractures. Delayed surgery increases UTI risk, and current prophylactic antibiotics are ineffective.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Geriatric Medicine
Background:
- Urinary tract infections (UTIs) are a common complication in patients with proximal femoral fractures.
- Routine audits indicated a significant incidence of UTIs during hospitalization for these fractures.
Purpose of the Study:
- To investigate the relationship between UTI and fracture type, surgical timing, and perioperative antibiotic use.
- To assess the actual prevalence of UTIs in patients with proximal femoral fractures.
Main Methods:
- Prospective study involving 88 patients over 4 months.
- Urine specimens collected intraoperatively and 48 hours postoperatively.
- Analysis of fracture type, age, operative delay, and antibiotic effects.
Main Results:
- 42% of patients had positive urine cultures 48 hours postoperatively; 12.5% were positive preoperatively.
- Females with intra-capsular fractures showed higher infection rates (P < 0.005).
- Advanced age (P < 0.05) and delayed surgery (>48h, P < 0.05) were risk factors for UTI.
Conclusions:
- Current audit methods underestimate UTI prevalence in proximal femoral fracture patients.
- Fracture type and operative delay are key determinants of postoperative UTIs.
- Prophylactic antibiotics did not prevent or eradicate early UTIs in this cohort.