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Study shows asymptomatic bacteriuria is an independent risk factor for PJI
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Researchers found asymptomatic bacteriuria is an independent risk factor of prosthetic joint infection, particularly due to gram-negative microorganisms. They also found that preoperative antibiotic treatments did little to reduce the rate of prosthetic joint infection in these cases.
“In some ways, the results were better than we ever hoped. Not only were we able to say there was a significant link between the two, but we also were able to say that not only does it increase your risk of prosthetic joint infection, we were able to support previous studies that said that antibiotic treatment was ineffective in reducing that risk,” Jonathan Quayle, MD, told Orthopaedics Europe Today.
Quayle is scheduled to present the study at the EFORT Congress.
“We were able to see that patients with asymptomatic bacteriuria (ASB) are susceptible to a particular kind of bacteria — the gram-negative bacteria. We are now considering what is the link? We proved association; we proved that there is a link between the two, so now what is the next step for us? That is what we ultimately have to ask, what is it that ultimately causes this and how can we reduce that. We know treating it doesn’t make a difference, it is just a marker for increased risk of PJI,” he said.
Antibiotic treatment has no effect
Quayle and colleagues enrolled consecutive total hip arthroplasty or total knee arthroplasty candidates in a prospective observational multicenter study from January 2010 to December 2011 which involved 2,497 patients in all. Sixty-three percent of patients were women and the average age of patients was 68 years. The minimum follow-up was 12 months.
For all patients a urine sample was cultured regardless of dipstick results and patients with ASB were identified. Preoperative antibiotic treatment was determined on an individual basis, so it was not mandatory or randomized.
The results showed an overall ASB prevalence of 12.1%; 16.3% in women and 5% in men. The overall PJI rate was 1.7%. The PJI rate was significantly higher in the ASB group at 4.3% than in the non-ASB group at 1.4%. Also, based on the results in the ASB group, there was no significant difference in PJI rates when patients were treated (3.9%) or not treated (4.7%) with antibiotics.
Economic effects examined
The study results, Quayle said, have already had interesting economic effects.
“It has led to change of practice with patients with symptoms of urinary infection. As they no longer have treatment with antibiotics, we do not have to do the routine screening anymore. This has saved us time and money,” Quayle told Orthopaedics Today Europe.
ASB is an independent risk factor for PJI particularly secondary to gram-negative microorganisms and antibiotic treatment did not reduce the rate of PJI, according to Quayle.
More measures need to be determined to reduce the infection rate further.
“We have now got a handle on a marker for PJI. We can now track down what is causing it, we have a chance of reducing PJI,” Quayle said. – by Robert Linnehan
- Reference:
- Quayle J. Paper #14-671. Scheduled to be presented June 4 at: 15th EFORT Congress – A Combined Program in Partnership With the BOA; June 4-6, 2014; London.
- For more information:
- Jonathan Quayle, MD, can be reached at the Frimley Park Hospital, Portsmouth Rd., Frimley, United Kingdom; email: jonathan.quayle@gmail.com.
Disclosure: Quayle has no relevant financial disclosures.
Perspective
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Mike Reed, MBBS MD FRCS FRCS(Tr & Orth)
This article is a most useful addition to the literature. A knowledge that the treatment of asymptomatic bacteriuria by current protocols is ineffective in prevention of surgical site infection is useful indeed. More useful, however, is the association the group found between asymptomatic bacteriuria and subsequent periprosthetic infection rate. This was most striking with rates being three times higher in the asymptomatic bacteriuria group. The researchers have essentially found a high risk group that can be easily identified preoperatively. These subsequent infections appear to be linked to gram-negative microorganisms although not specifically those isolated in the urine of those patients. We still do not know how to prevent infection in this high-risk group and to some extent this study does raise more questions than answers, but it certainly moves us forward in the understanding of surgical site infection.
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