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Are Antibiotics Necessary in Hip Arthroplasty With Asymptomatic Bacteriuria? Seeding Risk With/Without Treatment

  • Symposium: 2012 International Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

In patients with asymptomatic bacteriuria undergoing hip arthroplasty, the risk of prosthetic joint infection (PJI) and appropriateness of specific antibiotics are unclear.

Questions/purposes

We determined (1) the prevalence of asymptomatic bacteriuria; and (2) the incidence of PJI in patients with asymptomatic bacteriuria managed with or without specific antibiotics.

Methods

We conducted a prospective, randomized study of all 471 patients without urinary symptoms receiving a total hip arthroplasty (THA; n = 228; average age 68 years; 122 female) or hemiarthroplasty (HA; n = 243; average age 85 years; 170 female) between April 2009 and November 2010. No patients were catheterized in the perioperative period and all received intravenous cefazolin (allergy, vancomycin) for 48 hours postoperatively. Urinalysis was conducted on all patients; if abnormal, a urine culture was performed. Patients with bacteriuria (> 100,000 colonies/mL cultured) were randomly assigned to receive specific antibiotics (Group A) or not (Group B). Minimum followup was 1 month including those six who died or were lost to followup (average, 10.4 months; range, 1–12 months).

Results

Asymptomatic bacteriuria occurred in eight of 228 patients undergoing THAs (three of eight with specific antibiotics) and 38 of 243 patients undergoing HAs (23 of 38 with specific antibiotics). Arthroplasty infection after 3 months occurred in one of 228 patients undergoing THAs and 12 of 243 patients undergoing HAs (six of 117 in Group A and six of 126 in Group B); bacteria cultured from the wound were dissimilar to those cultured in urine samples in any case. No patient presented signs of PJI by 1 year after the index surgery.

Conclusions

We identified no case of PJI from urinary origin in patients with asymptomatic bacteriuria whether or not they had been treated with specific antibiotics.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Rosario Madero, statistician of La Paz Hospital (Madrid, Spain), for her assistance in the statistical calculations and her judicious advice.

Author information

Authors and Affiliations

  1. Orthopaedic Surgery Department, University Hospital La Princesa, Océano Antártico 41, Tres Cantos, 28760, Madrid, Spain

    José Cordero-Ampuero MD, PhD

  2. Orthopaedic Surgery Department, University Hospital La Princesa, Madrid, Spain

    Enrique González-Fernández MD & David Martínez-Vélez MD

  3. Microbiology Department, Fundación Jiménez Díaz, Madrid, Spain

    Jaime Esteban MD, PhD

Authors
  1. José Cordero-Ampuero MD, PhD
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  2. Enrique González-Fernández MD
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  3. David Martínez-Vélez MD
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  4. Jaime Esteban MD, PhD
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Corresponding author

Correspondence to José Cordero-Ampuero MD, PhD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved or waived approval for the reporting of this case and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at University Hospital La Princesa, Madrid, Spain.

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Cordero-Ampuero, J., González-Fernández, E., Martínez-Vélez, D. et al. Are Antibiotics Necessary in Hip Arthroplasty With Asymptomatic Bacteriuria? Seeding Risk With/Without Treatment. Clin Orthop Relat Res 471, 3822–3829 (2013). https://doi.org/10.1007/s11999-013-2868-z

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  • DOI: https://doi.org/10.1007/s11999-013-2868-z

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