Role of asymptomatic bacteriuria on early periprosthetic joint infection after hip hemiarthroplasty. BARIFER randomized clinical trial

Do urinary tract infections affect the rate of periprosthetic joint infections in patients who underwent arthroplasty surgery? A systematic review and meta-analysis

Periprosthetic joint infection (PJI) is a significant issue in orthopedic surgery. Urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB) have been identified as potential causes of PJI; however, evidence is inconclusive. Understanding these relationships is critical for improving therapy and patient outcomes. A systematic review was performed by conducting searches from PubMed, EBSCO, ProQuest, and manual searching with adherence to the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 guideline. Studies that reported UTI/ASB and PJI were included. Meta-analysis was conducted using a random-effects model using RevMan 5.4 software. A total of 14 studies were included with UTIs and ASB showed an overall association with increased risk of PJI (odds ratio [OR]: 1.84, 95% confidence interval [CI]: 1.14-2.99, P = 0.01). However, subgroup analysis for UTIs and ASB was not significant. Further analysis of UTIs in total hip arthroplasty (THA) surgery showed a significant association (OR: 1.76, 95% CI: 1.57-1.96) with PJI. Preoperative UTIs timing between 0 and 2 weeks before surgery showed an increased risk of PJI (OR: 1.45, 95% CI: 1.35-1.55). Antibiotic treatment in ASB did not significantly impact PJI rates. Urine and PJI sample cultures in four studies showed no correlation of microorganisms between the two sites. According to recent evidence, a statistically significant association was found between UTIs and PJI in patients who underwent THA surgery. However, ASB did not yield significant results in relation to PJI. These results should be supported by larger and well-designed studies to make proper clinical suggestion in future. For further research, it is recommended to adopt standardized criteria for outcome measurement and to involve larger sample sizes to enhance the reliability and generalizability of findings.

Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults

Purpose of review

Our goal was to summarize recent evidence regarding recurrent urinary tract infections and asymptomatic bacteriuria in different adult populations.

Recent findings

Several research groups are focused on the description of resident bacterial flora in the bladder and urinary dysbiosis in the microbiome era. Even the definitions might change in light of these discoveries. However, the role of urinary microbiome and bacterial interference has still to be determined.

Summary

Systematic treatment of asymptomatic bacteriuria is not recommended and even classic indications such as asymptomatic bacteriuria in pregnant women are controversial. In fact, its treatment is associated with a higher probability of symptomatic UTI and a higher prevalence of antibiotic-resistant bacteria. Improving the diagnosis of asymptomatic bacteriuria and optimizing the management of recurrent urinary tract infections, especially through non-antibiotics measures, are needed in order to minimise antimicrobial resistance.