Management of Asymptomatic Bacteriuria, Urinary Catheters and Symptomatic Urinary Tract Infections in Patients Undergoing Surgery for Joint Replacement: A Position Paper of the Expert Group 'Infection' of swissorthopaedics.

Parham Sendi,Martin Clauss,Ilker Uçkay,Peter Wahl,Olivier Borens

doi:10.7150/jbji.20425

Abstract

In this position paper, we review definitions related to this subject and the corresponding literature. Our recommendations include the following statements. Asymptomatic bacteriuria, asymptomatic leukocyturia, urine discolouration, odd smell or positive nitrite sediments are not an indication for antimicrobial treatment. Antimicrobial treatment of asymptomatic bacteriuria does not prevent periprosthetic joint infection, but is associated with adverse events, costs and antibiotic resistance development. Urine analyses or urine cultures in asymptomatic patients undergoing orthopaedic implants should be avoided. Indwelling urinary catheters are the most frequent reason for healthcare-associated urinary tract infections and should be avoided or removed as soon as possible.

Highlights

Periprosthetic joint infection (PJI) is a serious complication after arthroplasty
Lack of antibiotic treatment for asymptomatic bacteriuria (ASB) was not associated with a higher risk of postoperative PJI due to a microorganism previously found in the urine or a higher risk of postoperative symptomatic urinary tract infection (UTI)
In the work by Sousa et al [23], the presence of ASB was associated with a higher risk for PJI, irrespective of organisms found in the urine

Summary

Introduction

Periprosthetic joint infection (PJI) is a serious complication after arthroplasty. The relationship between abnormal results in urine analysis and potential risk for PJI often raises questions about the optimal management in patients undergoing surgery for joint replacementIn this position paper, we review definitions related to this subject and the corresponding literature. The definitions of http://www.jbji.net bacteriuria, pyuria, leukocyturia, asymptomatic bacteriuria (ASB) and symptomatic lower urinary tract infection (UTI) are presented in table 1 [1, 2]. In patients with a chronic indwelling urinary catheter, the rate of ASB is even higher (e.g., up to 100%, reviewed in [10](11)). Treatment of ASB in patients undergoing surgery for joint replacement

Results

Conclusion