Does Treatment of Preoperative Asymptomatic Bacteriuria Reduce the Rate of Postoperative Prosthetic Joint or Surgical Site Infection in Elective Joint Arthroplasty? A Systematic Review
DOI:
https://doi.org/10.12974/2313-0954.2018.05.4Keywords:
Asymptomatic bacteriuria, Elective joint arthroplasty, Prosthetic joint infection.Abstract
Introduction: Inconsistent guidelines for management of preoperative asymptomatic bacteriuria (ASB) prior to elective joint arthroplasty leads to practice variance, surgical delays and antimicrobial overuse. This systematic review examined whether: 1) preoperative ASB in patients awaiting elective arthroplasty was associated with increased rates of postoperative prosthetic joint (PJI) and surgical site infection (SSI) 2) treatment of ASB modifies these rates.
Methods: A textual narrative synthesis was performed of randomised control, quasiexperimental and observational studies (identified through MEDLINE, EMBASE, HMIC and grey literature resources), which included patients with ASB and an outcome measure of rate of PJI/SSI. Significant study heterogeneity precluded meta-analysis.
Results: Eleven studies (comprising a total of 31857 patients) were included: one randomised control, three quasiexperimental, and seven observational studies. Ten studies involved a control group to address whether ASB was associated with PJI/SSI. Eight out of these ten studies found no association between ASB and PJI/SSI; two studies found an association. Only four out of 239 cases across all studies grew identical pathogens in wound and urine cultures. One study only included patients with ASB and focused on whether treatment of ASB reduced PJI incidence. Two of the former ten studies also explored this. No studies reported that treatment of ASB reduced rates of PJI/SSI.
Conclusions: Treatment of ASB prior to joint arthroplasty does not reduce rates of PJI/SSI. Within the current climate of antibiotic stewardship and financial healthcare pressures, this review suggests that preoperative urine cultures should not be routinely sent in asymptomatic patients prior to elective joint arthroplasty.
References
Kurtz SM, Röder C, Lau E, Ong K, Widmer M, Maravic M et al. International Survey of Primary and Revision Total Hip Replacement. International Orthopaedics 2011; 35(12): 1783-9. https://doi.org/10.1007/s00264-011-1235-5
National Joint Registry for England, Wales, Northern Island and Isle of Man: 13th Annual Report 2016. http://www.njrcentre.org.uk/njrcentre/Reports, PublicationsandMinutes/Annualreports/tabid/86/Default.aspx (date last accessed 3 May 2017)
Gomez MM, Parvizi J. Periprosthetic joint infection in total knee arthroplasty: current concepts. Curr Orthop Pract 2015; 26(3): 247-251. https://doi.org/10.1097/BCO.0000000000000236
Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 2013; 95-B: 1450-2. https://doi.org/10.1302/0301-620X.95B11.33135
Cai T, Mazzoli S, Lanzafame P, Caciagli P, Malossini G, Nesi G et al. Asymptomatic Bacteriuria in Clinical Urological Practice: Preoperative Control of Bacteriuria and Management of Recurrent UTI. Pathogens 2016; 5(4). https://doi.org/10.3390/pathogens5010004
Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infec Dis 2005; 40(5): 643-54. https://doi.org/10.1086/427507
Ninan S, Walton C, Barlow G. Investigation of suspected urinary tract infection in older people. BMJ 2014; 348: g4070. https://doi.org/10.1136/bmj.g4070
Nicolle LE, Mayhew WJ, Bryan L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Am J Med.- 1987; 83: 27-33. https://doi.org/10.1016/0002-9343(87)90493-1
Nicolle LE, Bjornson J, Harding GK, MacDonell JA. Bacteriuria in elderly institutionalized men. N Eng J Med 1983; 309: 1420-5. https://doi.org/10.1056/NEJM198312083092304
Abrutyn E, Mossey J, Berlin JA, Boscia J, Levison M, Pitsakis P et al. Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women? Ann Intern Med 1994; 120: 827-33. https://doi.org/10.7326/0003-4819-120-10-199405150-00003
Ouslander JG, Schapira M, Schnelle JF, Uman G, Fingold S, Tuico E et al. Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents? Ann Intern Med 1995; 122: 749-54. https://doi.org/10.7326/0003-4819-122-10-199505150-00003
Mckenzie R, Stewart MT, Bellantoni MF, Finucane TE. Bacteriuria in individuals who become delirious. Am J Med 2014; 127(4): 255-257. https://doi.org/10.1016/j.amjmed.2013.10.016
Potts L, Cross S, MacLennan WJ, Watt B. A double-blind comparative study of norfloxacin versus placebo in hospitalised elderly patients with asymptomatic bacteriuria. Arch Gerontol Geriatr 1996; 23: 153-161. https://doi.org/10.1016/0167-4943(96)00715-7
Mayne AIW, Davies PSE, Simpson JM. Screening for asymptomatic bacteriuria before total joint arthroplasty. BMJ 2016; 354: i3569. https://doi.org/10.1136/bmj.i3569
Finnigan TKP, Bhutta MA, Shepard GJ. Asymptomatic bacteriuria prior to arthroplasty: How do you treat yours? Orthopaedic Proceedings 2012; 94-B(SUPP XXIX)58;
Primary total hip replacement: a guide to good practice. 3rd ed. British Orthopaedic Association, 2012.https://www.britishhipsociety.com/uploaded/Blue%20Bo ok%202012%20fsh%20nov%202012.pdf (date last accessed 3 May 2017)
Scottish Intercollegiate Guidelines Network. Guideline 88.Management of suspected bacterial urinary tract infection in adults.2012. http://www.sign.ac.uk/guidelines/- fulltext/88/recommendations.html (date last accessed 3 May 2017)
National Institute of Clinical Excellence.Guidelines QS90. Urinary Tract Infections in Adults.2015. https://www.nice.org.uk/guidance/qs90 (date last accessed 3 May 2017)
Duncan RA. Prosthetic Joint Replacement: Should orthopaedists check urine because it's there? Clin Infect Dis 2014; 59(1): 48-50. https://doi.org/10.1093/cid/ciu243
Systematic Reviews. CRD's guidance for undertaking reviews in health care. 2009. https://www.york.ac.uk/- media/crd/Systematic_Reviews.pdf (date last accessed 3 May 2017)
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions: The Cochrane Collaboration; 2011. www.cochrane-handbook.org (date last accessed 3 May 2017)
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health 1998; 52(6): 377-84. https://doi.org/10.1136/jech.52.6.377
Drekonja DM, Zarmbinski B, Johnson J. Preoperative urine cultures at a Veterans Affairs Medical Centre. JAMA Intern Med 2013; 173(1): 71-2. https://doi.org/10.1001/2013.jamainternmed.834
Cordero-Ampuero J1, González-Fernández E, Martínez- Vélez D, Esteban J. Are antibiotics necessary in hip arthroplasty with asymptomatic bacteriuria? Seeding risk with/without treatment. Clin Orthop Relat Res 2013; 471(12): 3822-9. https://doi.org/10.1007/s11999-013-2868-z
Sousa R, Munoz-Mahammud E, Quayle J, Dias da Costa L, Casals C, Scott P et al. Is asymptomatic bacteriuria a risk factor for prosthetic joint infection? Clin Infect Dis.2014; 59(1): 41-7. https://doi.org/10.1093/cid/ciu235
Lamb MJ, Baillie L, Pajak D, Flynn J, Bansal V, Simor A et al. Elimination of screening urine cultures prior to elective joint arthroplasty. Clin Infect Dis 2017; 64(6): 806-809. https://doi.org/10.1093/cid/ciw848
Martínez-Vélez D, González-Fernández, Esteban J, Cordero- Ampuero J. Prevalence of asymptomatic bacteriuria in knee arthroplasty patients and subsequent risk of prosthesis infection. Eur J Orthop Surg Traumatol 2016; 26(2): 209-14. https://doi.org/10.1007/s00590-015-1720-4
Ollivere BJ, Ellahee N, Logan K, Miller-Jones JCA, Allen PW. Asymptomatic urinary tract colonisation predisposes to superficial wound infection in elective orthopaedic surgery. Int Orthop 2009; 33(3): 847-850. https://doi.org/10.1007/s00264-008-0573-4
Singh H, Thomas S, Agarwal S, Arya SC, Srivastav S, Agarwal N. Total knee arthroplasty in women with asymptomatic urinary tract infection. J Orthop Surg (Hong Kong) 2015; 23(3): 298-300. https://doi.org/10.1177/230949901502300307
Bouvet C, Lubbeke A, Bandi C, Pagani L, Stern R, Hoffmeyer P et al. Is there any benefit in pre-operative urinary analysis before elective total joint replacement? Bone Joint J.2014; 96-B(3): 390-4. https://doi.org/10.1302/0301-620X.96B3.32620
Koulouvaris P, Sculco P, Finerty E, Sculco T, Sharrock NE. Relationship Between Perioperative Urinary Tract Infection and Deep Infection After Joint Arthroplasty. Clin Orthop Relat Res.2009; 467(7): 1859-1867. https://doi.org/10.1007/s11999-008-0614-8
Gou W, Chen J, Jia Y, Wang Y. Preoperative asymptomatic leucocyturia and early prosthetic joint infections in patients undergoing joint arthroplasty. J Arthroplasty.2014; 29(3): 473-6. https://doi.org/10.1016/j.arth.2013.07.028
Glynn MK, Sheehan JM. The significance of asymptomatic bacteriuria in patients undergoing hip/knee arthroplasty. Clin Orthop Relat Res.1984;( 185): 151-4. https://doi.org/10.1097/00003086-198405000-00026
National Institute of Clinical Excellence. Guidelines NG45. Routine preoperative tests for elective surgery. 2016. https://www.nice.org.uk/guidance/ng45.(date last accessed 3 May 2017)
Lawrence VA, Gafni A, Gross M. The unproven utility of the preoperative urinalysis: economic evaluation. J Clin Epidemiol.1989; 42(12): 1185-92. https://doi.org/10.1016/0895-4356(89)90117-0
Sendi P, Borens O, Wahl P, Clauss M, Uçkay I. Management of Asymptomatic Bacteriuria, Urinary Catheters and Symptomatic Urinary Tract Infections in Patients Undergoing Surgery for Joint Replacement: A Position Paper of the Expert Group 'Infection' of swissorthopaedics. J Bone Joint Infect 2017; 2(3): 154-159. https://doi.org/10.7150/jbji.20425
