Abstract
Deep joint infection is one of the most dreaded complications of total joint arthroplasty, and urinary tract infections (UTI) are generally believed to be a source for haematogenous seeding of the prosthetic joint. Although patients are often screened for UTI there appears to be minimal evidence on the management of asymptomatic bacteriuria, or for those patients who perform intermittent self-catheterisation prior to joint arthroplasty. This study aims to address this.
We performed an online and postal survey of the British Association for the Surgery of the Knee membership to provide a consensus from a body of professionals. Of the respondents 75% performed 50 or more joint arthroplasty surgery over a 12 month period. For all surgeons, 71.4% provided antibiotic cover for the insertion and withdrawal of urinary catheters. However, only 19% were aware of National guidelines, compared to 76.2% for local guidelines which were more likely to be followed. Two thirds of surgeons would treat asymptomatic bacteriuria prior to surgery, yet 70% of these surgeons were unable to cite evidence for this decision. Similarly, the management of patients requiring intermittent self-catherisation produced a heterogenous response.
Our study suggests there is a lack of consensus and/or awareness amongst specialist knee surgeons for the management of asymptomatic urinary bacteriuria in patients prior to knee surgery. We believe a minimum standard of care be defined by the society to protect both patient and surgeon.
