Advertisement for orthosearch.org.uk
Orthopaedic Proceedings Logo

Receive monthly Table of Contents alerts from Orthopaedic Proceedings

Comprehensive article alerts can be set up and managed through your account settings

View my account settings

Visit Orthopaedic Proceedings at:

Loading...

Loading...

Full Access

Hip

JOINT ARTHROPLASTY AND ASYMPTOMATIC BACTERURIA: WHAT IS THE EVIDENCE FOR CURRENT PRACTICE?

British Hip Society meeting (BHS) March 2016



Abstract

Introduction

Patients with asymptomatic bacteriuria (ASB) have a significantly increased risk of both superficial wound infection and deep infection following arthroplasty. Debate continues as to whether treatment of pre-operative ASB reduces the risk of subsequent prosthetic joint infection.

Patients/Materials & Methods

All arthroplasty units in Scotland were contacted by telephone and asked a standard series of questions regarding pre-operative urine testing in arthroplasty patients. A review of the literature was also performed.

Results

All arthroplasty units in Scotland test all patients’ urine pre-operatively. 55% of clinics dipstick urine and send a midstream urine (MSU) sample if dipstick positive. 45% send an MSU without urine dipstick testing. All treat a positive MSU with oral antibiotics via the patient's GP practice.

Discussion

Historically all arthroplasty patients have had urine testing as part of their routine pre-operative assessment, and this remains current British Hip Society guidance. Globally, antibiotic use is under increasing scrutiny. The evidence for treating pre-operative ASB with antibiotics appears to be lacking but this study suggests the majority of arthroplasty units continue to test for and treat ASB. Locally, this practice has been increasingly questioned by microbiologists and general practitioners. Irrespective of antibiotic treatment, we believe identifying patients with pre-operative ASB remains useful as ASB appears to represent a surrogate marker for immunocompromise. This allows patients to be warned of the increased infection risk and these patients may require altered peri-operative prophylactic antibiotic cover depending on local policy.

Conclusion

Evidence for pre-operative antibiotic treatment of ASB is lacking but the majority of arthroplasty units continue this practice. Identification of pre-operative ASB is useful to identify increased infection risk and need for potential altered prophylactic antibiotic cover. We recommend formation of a consensus among arthroplasty surgeons to guide practice.