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Sigmund A, Pappas MA, Shiffermiller JF. Preoperative Testing. Med Clin North Am 2024; 108:1005-1016. [PMID: 39341610 DOI: 10.1016/j.mcna.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Preoperative medical evaluation can minimize inefficiencies and improve outcomes. Thoughtful use of preoperative testing can aid in that effort, but, conversely, indiscriminate testing can detract from it. The United Kingdom National Institute for Health Care and Excellence, European Society of Anaesthesiology, and American Society of Anesthesiologists (ASA) have all stated that routine preoperative testing is not supported by evidence. Testing is supported only when clinical indications are present. Particularly in low-risk patients, such as those with an ASA classification of 1 or 2 who are undergoing ambulatory procedures, evidence suggests that preoperative testing fails to reduce the risk of complications.
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Affiliation(s)
- Alana Sigmund
- Weill Medical College of Cornell University; Arthroplasty Hospital for Special Surgery, 541 East 71st Street, New York, NY 10021, USA.
| | - Matthew A Pappas
- Department of Hospital Medicine, Cleveland Clinic, 9500 Euclid Avenue, Mail Stop G-10, Cleveland, OH 44195, USA; Center for Value-based Care Research, Cleveland Clinic, Cleveland, OH, USA; Outcomes Research Consortium, Cleveland, OH, USA
| | - Jason F Shiffermiller
- Division of Hospital Medicine, Department of Internal Medicine, University of Nebraska Medical Center, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
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2
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Durkin MJ, Schmitz V, Hsueh K, Ney K, Politi MC. Eliciting Clinician Perspectives on Asymptomatic Bacteriuria to Identify Targets for Antimicrobial Stewardship Education and Decision Support. Open Forum Infect Dis 2024; 11:ofae439. [PMID: 39145141 PMCID: PMC11322835 DOI: 10.1093/ofid/ofae439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
Background The aim of this study was to elicit clinicians' perspectives to help reduce antibiotic prescribing for asymptomatic bacteriuria and improve a patient-centered educational brochure for older adults with urinary tract infections or asymptomatic bacteriuria. Methods Between October 2023 and April 2024, we conducted semi-structured qualitative interviews of clinicians who treat patients aged ≥65 years for urinary tract infections or bacteria in the urine, at infectious disease clinics, community senior living facilities, memory care clinics, and general practice. We developed an interview guide based on a behavior change framework and thematically analyzed written transcripts of audio-recorded interviews using inductive and deductive coding techniques. Results We identified several common themes surrounding management of asymptomatic bacteriuria from clinicians. These included an emphasis on ordering and interpreting urine tests, tension between guidelines and individual patient care for older adults, use of epidemiologic data to influence prescribing practices, pre-prepared communication talking points, and interest in educational materials for patients and clinical teams. Conclusions Education about the need for symptoms to supplement urine testing, data about the impact of overuse of antibiotics, and oral and written communication strategies should be addressed to reduce antibiotic prescribing for asymptomatic bacteriuria.
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Affiliation(s)
- Michael J Durkin
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Viktoria Schmitz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Kevin Hsueh
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Katheryn Ney
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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3
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Ghaseminejad-Raeini A, Esmaeili S, Ghaderi A, Sharafi A, Azarboo A, Hoveidaei AH, Shafiei SH, Golbakhsh M. Is asymptomatic bacteriuria a noticeable risk factor for periprosthetic joint infection following total joint arthroplasty? A systematic review and meta-analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05415-1. [PMID: 39008073 DOI: 10.1007/s00402-024-05415-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Total joint arthroplasty (TJA) is a common procedure that improves the quality of life for severe arthritis patients. The rising demand for TJA places enormous financial strain on the world's healthcare systems, which is exacerbated by postoperative readmissions for complications such as periprosthetic joint infections (PJIs). We conducted a systematic review and meta-analysis to determine if asymptomatic bacteriuria (ASB) increases infection risk. METHODS We conducted searches in three databases: PubMed, Scopus, and Web of Science. Screening steps have been carried out according to PRISMA guidelines. The study focused on patients who had undergone TJA and exhibited ASB. Two reviewers independently screened, assessed quality, and extracted data. Meta-analysis used Mantel-Haenszel method. RESULTS Following full-text screening, 12 studies were deemed eligible for inclusion in the systematic review, encompassing a total of 42,592 patients. A heightened occurrence of PJI was observed among TJA patients with ASB in comparison to controls (OR [95%CI] = 3.47 [1.42-8.44]). However, microorganisms responsible for the PJIs differed from those identified in the urine cultures of ASB. Additionally, analyses indicate that preoperative antibiotic treatment for ASB does not significantly affect the subsequent risk of PJI (OR [95% CI] = 1.00 [0.42-2.39]). Unlike surgical site infection (SSI), which did not show a difference in the rate of occurrence between the two groups, TJA patients with ASB were more likely to experience superficial wound infection (OR [95%CI] = 3.81 [2.02-7.21]). CONCLUSION This review and meta-analysis confirm that ASB correlate with heightened risks of PJI and superficial infection in TJA patients. However, no relationship was found between ASB and PJI microorganisms which raise doubts about the role of ASB microorganisms as the direct cause of infection following TJA.
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Affiliation(s)
- Amirhossein Ghaseminejad-Raeini
- Orthopaedic Subspecialty Research Centre (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Esmaeili
- Orthopaedic Subspecialty Research Centre (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghaderi
- Orthopaedic Subspecialty Research Centre (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Sharafi
- Orthopaedic Subspecialty Research Centre (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Azarboo
- Orthopaedic Subspecialty Research Centre (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Human Hoveidaei
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Seyyed Hossein Shafiei
- Orthopaedic Subspecialty Research Centre (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Golbakhsh
- Orthopaedic Subspecialty Research Centre (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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4
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Rodríguez-Pardo D, Del Toro MD, Guío-Carrión L, Escudero-Sánchez R, Fernández-Sampedro M, García-Viejo MÁ, Velasco-Arribas M, Soldevila-Boixader L, Femenias M, Iribarren JA, Pulido-Garcia MDC, Navarro MD, Lung M, Corona PS, Almirante B, Pigrau C. Role of asymptomatic bacteriuria on early periprosthetic joint infection after hip hemiarthroplasty. BARIFER randomized clinical trial. Eur J Clin Microbiol Infect Dis 2021; 40:2411-2419. [PMID: 33864153 DOI: 10.1007/s10096-021-04241-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/30/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate preoperative asymptomatic bacteriuria (ASB) treatment to reduce early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture. METHODS Open-label, multicenter RCT comparing fosfomycin-trometamol versus no intervention with a parallel follow-up cohort without ASB. PRIMARY OUTCOME early-PJI after HHA. RESULTS Five hundred ninety-four patients enrolled (mean age 84.3); 152(25%) with ASB (77 treated with fosfomycin-trometamol/75 controls) and 442(75%) without. Despite the study closed without the intended sample size, ASB was not predictive of early-PJI (OR: 1.06 [95%CI: 0.33-3.38]), and its treatment did not modify early-PJI incidence (OR: 1.03 [95%CI: 0.15-7.10]). CONCLUSIONS Neither preoperative ASB nor its treatment appears to be risk factors of early-PJI after HHA. ClinicalTrials.gov Identifier: Eudra CT 2016-001108-47.
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Affiliation(s)
- Dolors Rodríguez-Pardo
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain. .,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.
| | - María Dolores Del Toro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Laura Guío-Carrión
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | - Rosa Escudero-Sánchez
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Fernández-Sampedro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ángel García-Viejo
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Internal Medicine Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - María Velasco-Arribas
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Internal Medicine Department (Infectious Diseases Division), Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Laura Soldevila-Boixader
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Magdalena Femenias
- Orthopedic Surgery Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - José Antonio Iribarren
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Donostia IIS Biodonostia, San Sebastián, Spain
| | | | - María Dolores Navarro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Mayli Lung
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo S Corona
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Septic and Reconstructive Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain
| | - Carles Pigrau
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain
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5
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Bierle DM, Raslau D, Regan DW, Sundsted KK, Mauck KF. Preoperative Evaluation Before Noncardiac Surgery. Mayo Clin Proc 2020; 95:807-822. [PMID: 31753535 DOI: 10.1016/j.mayocp.2019.04.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 01/19/2023]
Abstract
The medical complexity of surgical patients is increasing and medical specialties are frequently asked to assist with the perioperative management surgical patients. Effective pre-anesthetic medical evaluations are a valuable tool in providing high-value, patient-centered surgical care and should systematically address risk assessment and identify areas for risk modification. This review outlines a structured approach to the pre-anesthetic medical evaluation, focusing on the asymptomatic patient. It discusses the evidence supporting the use of perioperative risk calculation tools and focused preoperative testing. We also introduce important key topics that will be explored in greater detail in upcoming reviews in this series.
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Affiliation(s)
- Dennis M Bierle
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN.
| | - David Raslau
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Dennis W Regan
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Karna K Sundsted
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Karen F Mauck
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
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6
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Gupta S, Preece J, Haynes A, Becknell B, Ching C. Differentiating Asymptomatic Bacteriuria From Urinary Tract Infection in the Pediatric Neurogenic Bladder Population: NGAL As a Promising Biomarker. Top Spinal Cord Inj Rehabil 2020; 25:214-221. [PMID: 31548788 DOI: 10.1310/sci2503-214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: To evaluate whether urinary antimicrobial peptides (AMPs) can discriminate between asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) in pediatric patients with neurogenic bladder (NGB). Design/Methods: Bladder urine was collected from pediatric patients (≤18 years old) with NGB without augmentation cystoplasty. Patients were divided into the following groups based on symptomatology and results of urinalysis/urine culture: (a) UTI, (b) ASB, and (c) sterile. Urine AMPs β defense 1 (BD-1), neutrophil gelatinase-associated lipocalin (NGAL), cathelicidin (LL-37), hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), and human α defensin 5 (HD-5) were compared between groups by enzyme-linked immunosorbent assays. In addition, urines from pediatric controls without NGB or UTI were also analyzed. Significance was determined using Student's t test for parametric or Mann-Whitney U test for nonparametric data. A p value of <.05 was considered significant. Results: Thirty-six patients with NGB from a spinal dysraphism were evaluated: UTI, n = 6; ASB, n = 18; sterile, n = 12. These groups did not differ significantly by age but did significantly differ by gender (p = .0139). NGAL significantly differed between UTI and ASB groups (median 38.5 ng/mg vs 15.5 ng/mg, respectively; p = .0197) with a sensitivity and specificity of 82.4% and 83.3%, respectively. HIP/PAP, BD-1, HD-5, LL-37, and NGAL levels were all significantly higher in sterile NGB urines compared to 17 non-NGB pediatric controls (p < .0001, p = .0020, p = .0035, p = .0006, and p = .0339, respectively). Conclusion: All five urinary AMPs evaluated were significantly elevated in NGB patients compared to controls. NGAL levels may help differentiate between UTI and ASB in pediatric NGB patients.
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Affiliation(s)
- Sudipti Gupta
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, Ohio
| | - Janae Preece
- Department of Urology, Children's Hospital of Michigan, Detroit, Michigan
| | - Andria Haynes
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - Brian Becknell
- Division of Nephrology, Nationwide Children's Hospital, Columbus, Ohio
| | - Christina Ching
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, Ohio
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Zhang J, Zhang XY, Jiang FL, Wu YP, Yang BB, Liu ZY, Liu D. Antibiotic-impregnated bone cement for preventing infection in patients receiving primary total hip and knee arthroplasty: A meta-analysis. Medicine (Baltimore) 2019; 98:e18068. [PMID: 31804314 PMCID: PMC6919433 DOI: 10.1097/md.0000000000018068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Surgical-site infections after primary total joint arthroplasty (TJA) are a significant issue. Antibiotic-impregnated bone cement (AIBC) has been widely used for the treatment of infected joints, but routine use of AIBC in primary TJA remains controversial. In this systematic review, we evaluated the efficacy of AIBC in reducing surgical-site infections after primary TJA. METHODS We systematically searched Pubmed, EMbase, Cochrane Library, CMB, CNKI, and WanFang Data for studies (published until June 1, 2019) evaluating AIBC use in reducing infection rates. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Meta-analysis was performed using Review Manager 5.3 software. The registration number is CRD42017078341 in PROSPERO. RESULTS In total, 10 studies were included, resulting in a sample size of 13,909 arthroplasty cases. The overall pooled data demonstrated that, compared with systemic antibiotics, AIBC was more effective in decreasing deep infection rates (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.14-0.89, P = .030), although there were higher superficial infection rates with AIBC (OR = 1.53, 95% CI = 1.11-2.11, P = .010). Compared to systemic antibiotics alone, AIBC with systemic antibiotics significantly decreased deep infection rates (OR = 0.55, 95% CI = 0.41-0.75, P = .0001) but there was no difference in superficial infection rates (OR = 1.43, 95% CI = 0.81-2.54, P = .220). In the subgroup analysis, both randomized controlled trials and cohort studies had reduced deep infection rates after primary TJA (OR = 0.61, 95% CI = 0.37-0.99, P = .050 and OR = 0.49, 95% CI = 0.34-0.70, P = .0001, respectively). AIBC decreased deep infection rates in both total hip and knee arthroplasty (OR = 0.25, 95% CI = 0.12-0.52, P = .0002 and OR = 0.62, 95% CI = 0.45-0.87, P = .005, respectively). Deep infection rates were significantly decreased by AIBC with gentamicin (OR = 0.31, 95% CI = 0.20-0.49, P < .00001) but unaffected by AIBC with cefuroxime (OR = 0.35, 95% CI = 0.10-1.20, P = .100). Deep infection rates in the AIBC and control groups were similar when laminar airflow was applied to the operating room (OR = 0.90, 95% CI = 0.60-1.35, P = .620); however, without laminar airflow, the efficacy of AIBC in decreasing deep infection rates was significantly higher than that of control group (OR = 0.21, 95% CI = 0.08-0.59, P = .003). CONCLUSIONS AIBC may significantly decrease deep infection rates after primary total hip and knee arthroplasty, with or without systemic antibiotics.
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Affiliation(s)
- Jin Zhang
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji
- Xi’an Jiaotong University Health Science Center
| | - Xiao-Yu Zhang
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji
| | - Feng-Li Jiang
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji
| | - Yi-Ping Wu
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji
| | - Bei-Bei Yang
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji
| | - Zi-Yun Liu
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji
| | - Dong Liu
- Clinical Pharmacy Office, Baoji Central Hospital, Baoji
- Department of Pharmacology, Xi’an Jiaotong University Health Science Center, Xi’an, China
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8
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Sousa RJG, Abreu MA, Wouthuyzen-Bakker M, Soriano AV. Is Routine Urinary Screening Indicated Prior To Elective Total Joint Arthroplasty? A Systematic Review and Meta-Analysis. J Arthroplasty 2019; 34:1523-1530. [PMID: 30956050 DOI: 10.1016/j.arth.2019.03.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty, and prevention is of great importance. The genitourinary tract is a potential source of bacterial seeding and one that can be easily managed. Despite little supportive evidence, routine urine screening and subsequent treatment before elective surgery in patients without symptoms has found its way into clinical practice in many countries. This systematic review and meta-analysis aims to ascertain whether asymptomatic bacteriuria (ASB) is a risk factor for PJI and if so, whether preoperative antibiotic treatment is effective in reducing its risk. METHODS PubMed, Ovid Medline, and Cochrane databases were searched using a systematic strategy. Selection of papers was exclusive to include only those which offered information about PJI rate specifically in patients with or without asymptomatic abnormal urinalysis or bacteriuria and/or information on whether ASB patients were preoperatively treated with antibiotics or not to be included in the analysis. RESULTS Six-hundred sixty-three papers were screened, and 10 papers were ultimately included (28,588 patients). Results show an increased risk of developing PJI among ASB patients (odds ratio = 3.64, 95% confidence interval = 1.40-9.42). However, most PJI microorganisms are unrelated to those previously found in the urine and preoperative antibiotic therapy does not influence PJI risk (odds ratio = 0.98, 95% confidence interval = 0.39-2.44). CONCLUSION Routine urinary screening prior to elective total joint arthroplasty and treatment of asymptomatic patients is not recommended.
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Affiliation(s)
- Ricardo J G Sousa
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal; Department of Orthopedics, Grupo Trofa Saude - Hospital, Alfena e Gaia, Portugal; Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo TrofaSaude - Hospital, Porto, Gaia e Alfena, Portugal
| | - Miguel A Abreu
- Department of Infectious Diseases, Centro Hospitalar do Porto, Porto, Portugal; Department of Orthopedics, Grupo Trofa Saude - Hospital, Alfena e Gaia, Portugal; Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo TrofaSaude - Hospital, Porto, Gaia e Alfena, Portugal
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alex V Soriano
- Department of Infectious Diseases, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
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9
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Parvizi J, Koo KH. Should a Urinary Tract Infection Be Treated before a Total Joint Arthroplasty? Hip Pelvis 2019; 31:1-3. [PMID: 30899708 PMCID: PMC6414408 DOI: 10.5371/hp.2019.31.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/24/2022] Open
Abstract
Periprosthetic joint infection (PJI) is one of the most serious complications after total joint arthroplasty (TJA). The prevalence of urinary tract infection (UTI) is common, particularly among elderly women, a group for whom TJA may be required. The association between preoperative UTI and increased risk of PJI after TJA is unclear. We reviewed key articles concerning the relationship between UTIs and PJI, and summarized recommendations of international consensus on PJI, which was established in Philadelphia in July of 2018. In addition, we distinguish between symptomatic UTI and asymptomatic bacteriuria, because their causative effects on PJI are quite different.
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Affiliation(s)
- Javad Parvizi
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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10
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Gallegos Salazar J, O’Brien W, Strymish JM, Itani K, Branch-Elliman W, Gupta K. Association of Screening and Treatment for Preoperative Asymptomatic Bacteriuria With Postoperative Outcomes Among US Veterans. JAMA Surg 2019; 154:241-248. [PMID: 30540346 PMCID: PMC6439639 DOI: 10.1001/jamasurg.2018.4759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/14/2018] [Indexed: 11/14/2022]
Abstract
Importance Limited data suggest that screening for asymptomatic bacteriuria (ASB) prior to nonurologic procedures is not useful. However, high-quality evidence to support consensus recommendations and influence clinical practice is lacking. Objective To characterize the association between detection and treatment of preoperative ASB and postoperative outcomes. Design, Setting, and Participants This retrospective cohort study involved patients, predominantly male veterans, who underwent surgical procedures in 109 US facilities within the US Department of Veterans Affairs health care system from October 1, 2008, to September 30, 2013. Participants included patients (n = 68 265) who had cardiac, orthopedic, or vascular surgical procedures. Each received a planned clinician review of complete medical records for antimicrobial prophylaxis as well as 30-day surgical-site infection (SSI) and urinary tract infection (UTI) outcomes, and each had a preoperative urine culture result available within the 30 days prior to the procedure. Data analysis was performed from December 2016 to August 2018. Main Outcome and Measures The primary outcome was the association between preoperative ASB and postoperative SSI. The secondary outcomes included postoperative UTI and the association between antimicrobial therapy for ASB and postoperative infectious outcomes. Results In total, 68 265 patients (65 664 [96.2%] were men and 2601 [3.8%] were women, with a mean [SD] age of 64.6 [9.2] years) were identified, and 17 611 (25.8%) were eligible for inclusion in the primary analysis. Preoperative urine cultures were performed in 17 749 (26.0%) patients, and the results were positive in 755 (4.3%), of which 617 (81.7%) were classified as ASB. With adjustments for age, American Society of Anesthesiologists class, smoking status, race/ethnicity, sex, and diabetes status, patients with or without ASB had similar odds of SSI (2.4% vs 1.6%; adjusted odds ratio [aOR], 1.58; 95% CI, 0.93-2.70; P = .08). Receipt of antimicrobial therapy with activity against the ASB organism was not associated with a reduced SSI risk (aOR, 1.01; 95% CI, 0.28-3.65; P = .99). Urinary tract infection occurred in 14 (3.3%) of 423 patients with ASB and 196 (1.5%) of 12 913 patients without ASB (aOR, 1.42; 95% CI, 0.80-2.49; P = .22). Treatment or prophylaxis for the ASB organism similarly was not associated with reduced odds of postoperative UTI (aOR 0.68; 95% CI, 0.20-2.30; P = .54). The ASB organisms matched a postoperative wound culture in 2 cases, both Staphylococcus aureus. Conclusions and Relevance The findings of this study suggest that receipt of antimicrobial therapy with activity against ASB organisms identified in preoperative urine cultures was not associated with reductions in the risk for postoperative infections, including UTI and SSI; such findings suggest there is evidence for discontinuing the practice of screening and treatment for preoperative ASB.
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Affiliation(s)
- Jaime Gallegos Salazar
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - William O’Brien
- VA Center for Healthcare Organization and Implementation Research, Boston, Massachusetts
| | - Judith M. Strymish
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kamal Itani
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Westyn Branch-Elliman
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts
- VA Center for Healthcare Organization and Implementation Research, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kalpana Gupta
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- VA Center for Healthcare Organization and Implementation Research, Boston, Massachusetts
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General Assembly, Prevention, Host Related Local: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S3-S12. [PMID: 30352771 DOI: 10.1016/j.arth.2018.09.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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12
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Cizmic Z, Feng JE, Huang R, Iorio R, Komnos G, Kunutsor SK, Metwaly RG, Saleh UH, Sheth N, Sloan M. Hip and Knee Section, Prevention, Host Related: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S255-S270. [PMID: 30348549 DOI: 10.1016/j.arth.2018.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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