Current evidence does not support systematic antibiotherapy prior to joint arthroplasty in patients with asymptomatic bacteriuria-a meta analysis
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Many orthopaedic surgeons worry about asymptomatic bacteriuria (ASB) as a possible risk factor for prosthetic joint infection (PJI). However, available evidence establishing a direct link between ASB and PJI is limited. This meta-analysis aimed to investigate whether ASB is a factor for PJI and whether pre-operative antibiotic treatment shows benefit.
We systematically searched major databases such as PubMed, Web of Science, the Cochrane Library and EMBASE for studies. Risk ratio (RR) was calculated for included studies that reported raw counts with 95% confidence interval (CI).
Five studies involved 3588 joint arthroplasties and 441 cases of ASB (overall incidence 12.3%). Compared with the control group, PJI was more common in both patients in the ASB group (RR = 2.87; 95% CI, 1.65–5.00). But in all five studies, the micro-organisms isolated from PJI and urine cultures were not the same. Three of the five studies reported that the antibiotic treated the ASB prior to joint arthroplasty and compared the untreated ASB group.There was no significant difference between groups (RR = 0.89; 95% CI, 0.36–2.20).
PJI occurring via the haematogenous route from the genitourinary tract harbouring bacteria in ASB is impossible. Pre-operative antibiotic treatment has no benefit. A plausible explanation could be an indicator of frailty and increased susceptibility to infection.
ASB increased the risk of PJI in the meta-analysis. However, current evidence does not support systematic antibiotherapy prior to joint arthroplasty and screening for ASB.
KeywordsProsthetic joint infections Asymptomatic bacteriuria Urinary analysis Joint arthroplasty Prophylactic antibiotics Meta-analysis
Compliance with ethical standards
The authors have nothing to disclose.
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
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