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Current evidence does not support systematic antibiotherapy prior to joint arthroplasty in patients with asymptomatic bacteriuria-a meta analysis

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Abstract

Background

Many orthopaedic surgeons worry about asymptomatic bacteriuria (ASB) as a possible risk factor for prosthetic joint infection (PJI). However, available evidence establishing a direct link between ASB and PJI is limited. This meta-analysis aimed to investigate whether ASB is a factor for PJI and whether pre-operative antibiotic treatment shows benefit.

Method

We systematically searched major databases such as PubMed, Web of Science, the Cochrane Library and EMBASE for studies. Risk ratio (RR) was calculated for included studies that reported raw counts with 95% confidence interval (CI).

Results

Five studies involved 3588 joint arthroplasties and 441 cases of ASB (overall incidence 12.3%). Compared with the control group, PJI was more common in both patients in the ASB group (RR = 2.87; 95% CI, 1.65–5.00). But in all five studies, the micro-organisms isolated from PJI and urine cultures were not the same. Three of the five studies reported that the antibiotic treated the ASB prior to joint arthroplasty and compared the untreated ASB group.There was no significant difference between groups (RR = 0.89; 95% CI, 0.36–2.20).

Discussion

PJI occurring via the haematogenous route from the genitourinary tract harbouring bacteria in ASB is impossible. Pre-operative antibiotic treatment has no benefit. A plausible explanation could be an indicator of frailty and increased susceptibility to infection.

Conclusions

ASB increased the risk of PJI in the meta-analysis. However, current evidence does not support systematic antibiotherapy prior to joint arthroplasty and screening for ASB.

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Authors and Affiliations

  1. Faculty of Graduate Studies, Guangxi University of Chinese Medicine, No.179 Mingxiu Dong Road, Nanning, Guangxi Zhuang Autonomous Region, 530001, China

    Chenglong Wang

  2. Department of Orthopedics, The People’s Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Nanning, Guangxi Zhuang Autonomous Region, 530001, China

    Dong Yin, Weifa Shi, Wenwen Huang & Deling Zuo

  3. Department of Orthopedics, Renmin Hospital of Wuhan University, No. 99 Jiefang Road, Wuhan, Hubei Province, 430060, China

    Qiang Lu

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  1. Chenglong Wang
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  2. Dong Yin
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  4. Wenwen Huang
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  5. Deling Zuo
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  6. Qiang Lu
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Correspondence to Dong Yin.

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The authors declare that they have no conflict of interest.

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Wang, C., Yin, D., Shi, W. et al. Current evidence does not support systematic antibiotherapy prior to joint arthroplasty in patients with asymptomatic bacteriuria-a meta analysis. International Orthopaedics (SICOT) 42, 479–485 (2018). https://doi.org/10.1007/s00264-018-3765-6

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  • DOI: https://doi.org/10.1007/s00264-018-3765-6

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