Risk of infection following total knee arthroplasty in patients with asymptomatic bacteriuria: A meta-analysis

Abstract

Introduction: In recent years, the treatment of asymptomatic bacteriuria (AB) is a topic approached in the orthopedic literature, with conflicting results about the need for treatment in the preoperative total knee arthroplasty (TKA). Objective: Systematic review with meta-analysis relating the presence of AB, as preoperative routine finding, to the risk of surgical site infection (SSI) following TKA, as well as the need for preoperative treatment of this condition. Methods: For the systematic review performed, five original articles were selected, following the PRISMA-p 2015. The keywords such as “asymptomatic bacteriuria” and “arthroplasty” or “joint replacement” or “joint infection” were used for the literature search in the databases of Bireme, PubMed, Medline, Science Direct, Google Scholars, and SciElo, between January and July 2018. Statistical analysis using the Mantel–Haenszel method and statistical test of relative risk with random effects were performed. Risks for publication bias were examined using a funnel plot. All analyzes were conducted using Review Manager version 5.3. Results: The results were inconclusive as to the increase in infection rates in patients undergoing TKA with AB. Conclusion: The study showed that the treatment of AB with antibiotics in the TKA preoperative period remains controversial due to the lack of data that reinforce this hypothesis.