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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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Probst A, Langenhan R. Letter to the Editor on "Is Routine Urinary Screening Indicated Prior to Elective Total Joint Arthroplasty? A Systematic Review and Meta-Analysis". J Arthroplasty 2019; 34:2193-2194. [PMID: 31256918 DOI: 10.1016/j.arth.2019.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/23/2019] [Indexed: 02/01/2023] Open
Affiliation(s)
- Axel Probst
- Department of Orthopaedic Surgery, Hegau-Bodensee-Klinikum Singen, Singen, Germany
| | - Ronny Langenhan
- Department of Orthopaedic Surgery, Hegau-Bodensee-Klinikum Singen, Singen, Germany
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Sousa RJG, Abreu MA. Reply to the Letter to the Editor on "Is Routine Urinary Screening Indicated Prior to Elective Total Joint Arthroplasty? A Systematic Review and Meta-Analysis". J Arthroplasty 2019; 34:2194-2195. [PMID: 31229374 DOI: 10.1016/j.arth.2019.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 02/01/2023] Open
Affiliation(s)
- Ricardo J G Sousa
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel A Abreu
- Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo Trofa Saude, Hospital em Alfena e Gaia, Vila Nova de Gaia, Portugal; Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Porto, Portugal
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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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Batibay SG, Soylemez S, Türkmen İ, Bayram Y, Camur S. The effectiveness of preoperative colon cleansing on post-operative surgical site infection after hip hemiarthroplasty. Eur J Trauma Emerg Surg 2019; 46:1071-1076. [PMID: 30949742 DOI: 10.1007/s00068-019-01125-1] [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] [Received: 09/12/2018] [Accepted: 03/29/2019] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to evaluate the effectiveness of prophylactic mechanical bowel preparation in elderly patients undergoing hip hemiarthroplasty in a single training institution over a period of 2 years. PATIENTS AND METHODS The study was conducted in a prospective-randomised manner. All patients, who underwent primary hip hemiarthroplasty for femoral neck fracture in our institution between 20 February 2015 and 29 December 2016, were included. B.T. Enema (sodium dihydrogen phosphate + disodium hydrogen phosphate) 135 ml (Yenisehir Laboratory, Ankara, Turkey) was used for colon cleansing. RESULTS Ninety-five patients were followed up for at least 1 year after surgery (16.3 ± 4.2 months). Of these, 46 were in the enema group and 49 were in the control group. Demographic and clinical characteristics of patients were similar in both groups (p > 0.05). Infection rates between the two groups were not significantly different (p > 0.05). In addition, ASA, age, sex, presence of diabetes mellitus, duration of surgery, time to surgery, ambulation status and blood count did not have a significant effect on surgical site infections (p > 0.05). However, all infections in the enema group were monobacterial and were successfully treated, whereas two of the four infections in the control group were polymicrobial and could not be successfully treated. CONCLUSION Although preoperative colon cleansing did not reduce the overall incidence of post-operative infections, our study suggested that it may reduce polymicrobial infections after hip hemiarthroplasty. Polymicrobial infections after hip hemiarthroplasty seem to have worse prognosis. Therefore, the effectiveness of preoperative colon cleansing in remediating such infections must be investigated in a larger number of patients.
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Affiliation(s)
- Sefa Giray Batibay
- Derince Education and Research Hospital, Department of Orthopedics and Trauma, SB University, Kocaeli, Turkey.
- , Kosuyolu/Istanbul, Turkey.
| | - Salih Soylemez
- Istanbul Fatih Sultan Mehmet Education and Research Hospital, Department of Orthopaedics and Trauma, SB University, Istanbul, Turkey
| | - İsmail Türkmen
- Umraniye Education and Research Hospital, Department of Orthopedics and Trauma, SB University, Istanbul, Turkey
| | - Yusuf Bayram
- Umraniye Education and Research Hospital, Department of Orthopedics and Trauma, SB University, Istanbul, Turkey
| | - Savas Camur
- Umraniye Education and Research Hospital, Department of Orthopedics and Trauma, SB University, Istanbul, Turkey
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Gómez-Ochoa SA, Espín-Chico BB, García-Rueda NA, Vega-Vera A, Osma-Rueda JL. Risk of Surgical Site Infection in Patients with Asymptomatic Bacteriuria or Abnormal Urinalysis before Joint Arthroplasty: Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2019; 20:159-166. [DOI: 10.1089/sur.2018.201] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sergio Alejandro Gómez-Ochoa
- School of Medicine, Health Sciences Faculty, Department of Surgery, Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | - Nicolás Andrés García-Rueda
- School of Medicine, Health Sciences Faculty, Department of Surgery, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Agustín Vega-Vera
- School of Medicine, Health Sciences Faculty, Department of Surgery, Universidad Industrial de Santander, Bucaramanga, Colombia
- Department of Internal Medicine, Department of Surgery, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - José Luis Osma-Rueda
- School of Medicine, Health Sciences Faculty, Department of Surgery, Universidad Industrial de Santander, Bucaramanga, Colombia
- Grupo de Investigación de Cirugía y Especialidades (GRICES-UIS), Department of Surgery, Universidad Industrial de Santander, Bucaramanga, Colombia
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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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