Is Asymptomatic Bacteriuria a Risk Factor for Prosthetic Joint Infection?

• Published in: Clinical infectious diseases 2014-07, Vol.59 (1), p.41-47
• Main Authors: Sousa, Ricardo, Muñoz-Mahamud, Ernesto, Quayle, Jonathan, da Costa, Luis Dias, Casals, Cristina, Scott, Phylip, Leite, Pedro, Vilanova, Paz, Garcia, Sebastian, Ramos, Maria Helena, Dias, Joana, Soriano, Alex, Guyot, Andrea
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; and Commentaries; Arthritis, Infectious - epidemiology; Arthroplasty; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; ARTICLES AND COMMENTARIES; Bacteria; Bacterial diseases; Bacterial diseases of the urinary system; Bacterial infections; Bacteriuria; Bacteriuria - complications; Biological and medical sciences; Cohort Studies; Diseases of the osteoarticular system; Escherichia coli; Female; Human bacterial diseases; Humans; Infections; Infectious diseases; Joint prostheses; Joint surgery; Knee joint; Male; Medical sciences; Microorganisms; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Predisposing factors; Prosthesis-Related Infections - epidemiology; Risk Assessment; Risk Factors; Surgical outcomes; Urinary tract infections; Urine; Young Adult
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciu235

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.