Are Antibiotics Necessary in Hip Arthroplasty With Asymptomatic Bacteriuria? Seeding Risk With/Without Treatment
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
In patients with asymptomatic bacteriuria undergoing hip arthroplasty, the risk of prosthetic joint infection (PJI) and appropriateness of specific antibiotics are unclear.
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.
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).
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.
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.
- Ainscow DA, Denham RA. The risk of hematogenous infection in total joint replacements. J Bone Joint Surg Br. 1984;66:580–582.
- American Urological Association and American Academy of Orthopaedic Surgeons. Antibiotic prophylaxis for urological patients with total joint replacements. J Urol. 2003;169:1796–1797. CrossRef
- Ariza J, Euba G, Murillo O. [Orthopaedic device-related infections] [in Spanish]. Enferm Infect Microbiol Clin. 2008;26:380–390. CrossRef
- Bengtsson C, Bengtsson U, Björkelund C, Lincoln K, Sigurdsson JA. Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden. Scand J Urol Nephrol. 1998;32:284. CrossRef
- Colgan R, Nicolle LE, McGlone A, Hooton TM. Asymptomatic bacteriuria in adults. Am Fam Physician. 2006;74:985–990.
- Cordero-Ampuero J, de Dios M. What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties? Clin Orthop Relat Res. 2010;468:3268–3277. CrossRef
- Cumming D, Parker MJ. Urinary catheterization and deep wound infection after hip fracture surgery. Int Orthop. 2007;31:483–485. CrossRef
- David TS, Vrahas MS. Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty. J Am Acad Orthop Surg. 2000;8:66–74.
- Gleckman R, Esposito A, Crowley M, Natsios GA. Reliability of a single urine culture in establishing diagnosis of asymptomatic bacteriuria in adult males. J Clin Microbiol. 1979;9:596–597.
- Glynn MK, Sheehan JM. The significance of asymptomatic bacteriuria in patients undergoing hip/knee arthroplasty. Clin Orthop Relat Res. 1984;185:151–154.
- Hooton TM, Scholes D, Stapleton AE, Roberts PL, Winter C, Gupta K, Samadpour M, Stamm WE. A prospective study of asymptomatic bacteriuria in sexually active young women. N Engl J Med. 2000;343:992. CrossRef
- Irvine R, Johnson BL Jr, Amstutz HC. The relationship of genitourinary tract procedures and deep sepsis after total hip replacements. Surg Gynecol Obstet. 1974;139:701–706.
- Jahoda D, Nyc O, Simsa J. Late hematogenous infection of prosthetic joint. Acta Chir Orthop Traumatol Cech. 2008;75:88–92.
- Juthani-Mehta M. Asymptomatic bacteriuria and urinary tract infection in older adults. Clin Geriatr Med. 2007;23:585–594. CrossRef
- Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008;23:984–991. CrossRef
- Lai K, Bohm ER, Burnell C, Hedden DR. Presence of medical comorbidities in patients with infected primary hip or knee arthroplasties. J Arthroplasty. 2007;22:651–656. CrossRef
- Maderazo E, Judson S, Pasternak H. Late infections of total joint prostheses. A review and recommendations for prevention. Clin Orthop Relat Res. 1988;229:131–142.
- Nicolle LE. Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin North Am. 2003;17:367–394. CrossRef
- Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40:643–654. CrossRef
- Otermin I, Rivero M, Hidalgo A. Is it necessary to delay or to put off surgery in the case of possible asymptomatic bacteriuria and orthopaedic surgery with implants? Enferm Infect Microbiol Clin. 2009;27:252–253. CrossRef
- Parvizi J, Morrison WB, Alavi A. Diagnostic imaging of periprosthetic joint infections. In: Cierny G III, McLaren AC, Wongworawat MD, eds. Orthopaedic Knowledge Update: Musculoskeletal Infection. Rosemont, IL, USA: American Academy of Orthopaedic Surgeons; 2009:67–72.
- Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing and predisposing factors. Clin Orthop Relat Res. 2008;466:1710–1715. CrossRef
- Rajamanickam A, Noor S, Usmani A. Should an asymptomatic patient with an abnormal urinalysis (bacteriuria or pyuria) be treated with antibiotics prior to major joint replacement surgery? Cleve Clin J Med. 2007;74(Suppl 1):S17. CrossRef
- Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br. 2005;87:844–850.
- Ritter MA, Fechtman RW. Urinary tract sequelae: possible influence on joint infections following total joint replacement. Orthopedics. 1987;10:467–469.
- Rodríguez-Baño J, Del Toro MD, Lupión C, Suárez AI, Silva L, Nieto I, Muniain MA. Arthroplasty-related infection: incidence, risk factors, clinical features and outcome. Enferm Infect Microbiol Clin. 2008;26:614–620. CrossRef
- Rogmark C, Carlsson A, Johnell O, Sernbo I. Primary hemiarthroplasty in old patients with displaced femoral neck fracture: a 1-year follow-up of 103 patients aged 80 years or more. Acta Orthop Scand. 2002;73:605–610. CrossRef
- Salvati EA, Della Valle AG, Masri BA, Duncan CP. The infected total hip arthroplasty. Instr Course Lect. 2003;52:223–246.
- Salvati EA, Im VC, Aglietti P, Wilson PD Jr. Radiology of total hip replacements. Clin Orthop Relat Res. 1976;121:74–82.
- Southwell-Keely J, Russo R, March L, Cumming R, Cameron I, Brnabic A. Antibiotic prophylaxis in hip fracture surgery: a metaanalysis. Clin Orthop Relat Res. 2004;419:179–184. CrossRef
- Tigges S, Stiles RG, Robertson JR. Appearance of septic hip prostheses on plain radiographs. AJR Am J Roentgenol. 1994;163:377–380. CrossRef
- Wymenga AB, van Horn JR, Theeuwes A, Muytjens HL, Slooff TJ. Perioperative factors associated with septic arthritis after arthroplasty. Prospective multicenter study of 362 knee and 2651 hip operations. Acta Orthop Scand. 1992;63:665–671.
- Are Antibiotics Necessary in Hip Arthroplasty With Asymptomatic Bacteriuria? Seeding Risk With/Without Treatment
Clinical Orthopaedics and Related Research®
Volume 471, Issue 12 , pp 3822-3829
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Orthopaedic Surgery Department, University Hospital La Princesa, Océano Antártico 41, Tres Cantos, 28760, Madrid, Spain
- 2. Orthopaedic Surgery Department, University Hospital La Princesa, Madrid, Spain
- 3. Microbiology Department, Fundación Jiménez Díaz, Madrid, Spain