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Pre-operative asymptomatic bacteriuria: a risk factor for prosthetic joint infection?

Pre-operative asymptomatic bacteriuria: a risk factor for prosthetic joint infection?
Pre-operative asymptomatic bacteriuria: a risk factor for prosthetic joint infection?

Background: Infection is a rare complication following implantation of prosthetic material into a joint. The impact of asymptomatic bacteriuria (ASB) before elective operations and the subsequent risk of prosthetic joint infection (PJI) are not well understood.

Aims: To assess the prevalence of ASB amongst patients undergoing total arthroplasty of the hip and knee; and to determine the rates of PJI diagnosed within two years of the arthroplasty and if ASB is an independent risk factor for developing PJI.

Methods: Patients who had total/unicondylar knee or total hip arthroplasty were reviewed retrospectively over a five-year period. Pre-operative urine samples within one year of surgery were analysed, and those with ASB were identified. The primary outcome was PJI within the first postoperative year.

Findings: In total, 5542 patients were included. Of these, 4368 had a pre-operative urine culture recorded. The prevalence of ASB was 140 of 4368 (3.2%). The overall PJI rate was 56 of 5542 (1.01%). Of those with PJI, 33 had a pre-operative urine sample recorded. The infection rates were 5% (seven of 140) in the ASB group, 0.61% (26 of 4228) in the no-ASB group and 1.96% (23 of 1174) in the group without a urine sample (P < 0.001). The ASB isolate was the same micro-organism as the PJI isolate in one of the seven cases.

Conclusion: The association between ASB and PJI is statistically significant, but the urine isolates did not relate to the isolates in the prosthetic joint, suggesting that the relationship is unlikely to be causal.

Asymptomatic bacteriuria, Joint prosthesis, MSSA, Pre-operative screening, Prosthetic joint infection
0195-6701
210-213
Weale, R.
45125899-e3ea-470e-a57c-301afa466832
El-Bakri, F.
6ec48c99-b89c-48d5-8fb5-02f4cda09acf
Saeed, K.
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Weale, R.
45125899-e3ea-470e-a57c-301afa466832
El-Bakri, F.
6ec48c99-b89c-48d5-8fb5-02f4cda09acf
Saeed, K.
87cb67e5-71e8-4759-bf23-2ea00ebd8b39

Weale, R., El-Bakri, F. and Saeed, K. (2019) Pre-operative asymptomatic bacteriuria: a risk factor for prosthetic joint infection? Journal of Hospital Infection, 101 (2), 210-213. (doi:10.1016/j.jhin.2018.04.011).

Record type: Article

Abstract

Background: Infection is a rare complication following implantation of prosthetic material into a joint. The impact of asymptomatic bacteriuria (ASB) before elective operations and the subsequent risk of prosthetic joint infection (PJI) are not well understood.

Aims: To assess the prevalence of ASB amongst patients undergoing total arthroplasty of the hip and knee; and to determine the rates of PJI diagnosed within two years of the arthroplasty and if ASB is an independent risk factor for developing PJI.

Methods: Patients who had total/unicondylar knee or total hip arthroplasty were reviewed retrospectively over a five-year period. Pre-operative urine samples within one year of surgery were analysed, and those with ASB were identified. The primary outcome was PJI within the first postoperative year.

Findings: In total, 5542 patients were included. Of these, 4368 had a pre-operative urine culture recorded. The prevalence of ASB was 140 of 4368 (3.2%). The overall PJI rate was 56 of 5542 (1.01%). Of those with PJI, 33 had a pre-operative urine sample recorded. The infection rates were 5% (seven of 140) in the ASB group, 0.61% (26 of 4228) in the no-ASB group and 1.96% (23 of 1174) in the group without a urine sample (P < 0.001). The ASB isolate was the same micro-organism as the PJI isolate in one of the seven cases.

Conclusion: The association between ASB and PJI is statistically significant, but the urine isolates did not relate to the isolates in the prosthetic joint, suggesting that the relationship is unlikely to be causal.

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More information

Accepted/In Press date: 6 April 2018
e-pub ahead of print date: 13 April 2018
Published date: February 2019
Keywords: Asymptomatic bacteriuria, Joint prosthesis, MSSA, Pre-operative screening, Prosthetic joint infection

Identifiers

Local EPrints ID: 422980
URI: http://eprints.soton.ac.uk/id/eprint/422980
ISSN: 0195-6701
PURE UUID: 6a9e7ea9-c814-4e3c-9aed-567d0b226d8e
ORCID for K. Saeed: ORCID iD orcid.org/0000-0003-0123-0302

Catalogue record

Date deposited: 09 Aug 2018 16:30
Last modified: 16 Mar 2024 04:41

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Contributors

Author: R. Weale
Author: F. El-Bakri
Author: K. Saeed ORCID iD

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