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Lu S, Marquez I, Shahzad H, Ochoa J, Parhar K, Jawad M, Roberto R, Javidan Y, Khan S, Klineberg E, Le H. Utility of Routine Preoperative Urinalysis in Elective Lumbar Spine Fusion Surgery. Global Spine J 2025:21925682251330593. [PMID: 40152758 PMCID: PMC11954378 DOI: 10.1177/21925682251330593] [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: 12/09/2024] [Revised: 02/10/2025] [Accepted: 03/12/2025] [Indexed: 03/29/2025] Open
Abstract
Study DesignA retrospective cohort study.ObjectiveTo evaluate the utility of routine preoperative urinalysis as a predictor of postoperative complications following elective lumbar fusion surgery (ELFS).MethodsThis study included a retrospective review of patients aged ≥18 years-old who underwent ELFS for degenerative pathology between 2018 to 2022 at a single academic institution. Patients were categorized into 3 groups: No Urinalysis (No-UA), Negative Urinalysis (Negative-UA), and Positive Urinalysis (Positive-UA). A retrospective review of medical records was conducted including patient characteristics and clinical factors of interest. Emergency department (ED) visits and return to the operating room (OR) within 3-months postoperatively were recorded. Statistical analyses were performed using bivariate and multivariate analysis.ResultsA total of 493 patients were included. Despite having higher rates of preoperative antibiotics administered, patients with a positive urinalysis were significantly more likely to present with postoperative urinary tract infections (UTIs) than the No-UA and Negative-UA groups. No significant differences were seen in other types of complications including pneumonia, bacteremia, superficial wound infections, deep wound infections, and wound dehiscence between the 3 groups. Additionally, rates of return to OR, return to ED, reinsertion of foley catheters, duration of indwelling catheterization, and hospital length of stay had no significant differences between the groups.ConclusionThis study suggests there may be a limited role in performing routine preoperative urinalysis prior to ELFS. This study may help further improve preoperative assessment guidelines and assist with patient counseling and considerations prior to elective lumbar fusion surgery.
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Affiliation(s)
- Stevin Lu
- Creighton School of Medicine, Omaha, NE, USA
| | - Ian Marquez
- UC Davis Medical Center, Sacramento, CA, USA
| | | | | | - Kanwar Parhar
- Elson S. Floyd College of Medicine, Spokane, WA, USA
| | | | | | | | - Safdar Khan
- UC Davis Medical Center, Sacramento, CA, USA
| | - Eric Klineberg
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hai Le
- UC Davis Medical Center, Sacramento, CA, USA
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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; 144:5205-5216. [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] [MESH Headings] [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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Durkin MJ, Schmitz V, Hsueh K, Ney K, Politi MC. Eliciting Clinician Perspectives on Asymptomatic Bacteriuria to Identify Targets for Antimicrobial Stewardship Education and Decision Support. Open Forum Infect Dis 2024; 11:ofae439. [PMID: 39145141 PMCID: PMC11322835 DOI: 10.1093/ofid/ofae439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
Background The aim of this study was to elicit clinicians' perspectives to help reduce antibiotic prescribing for asymptomatic bacteriuria and improve a patient-centered educational brochure for older adults with urinary tract infections or asymptomatic bacteriuria. Methods Between October 2023 and April 2024, we conducted semi-structured qualitative interviews of clinicians who treat patients aged ≥65 years for urinary tract infections or bacteria in the urine, at infectious disease clinics, community senior living facilities, memory care clinics, and general practice. We developed an interview guide based on a behavior change framework and thematically analyzed written transcripts of audio-recorded interviews using inductive and deductive coding techniques. Results We identified several common themes surrounding management of asymptomatic bacteriuria from clinicians. These included an emphasis on ordering and interpreting urine tests, tension between guidelines and individual patient care for older adults, use of epidemiologic data to influence prescribing practices, pre-prepared communication talking points, and interest in educational materials for patients and clinical teams. Conclusions Education about the need for symptoms to supplement urine testing, data about the impact of overuse of antibiotics, and oral and written communication strategies should be addressed to reduce antibiotic prescribing for asymptomatic bacteriuria.
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Affiliation(s)
- Michael J Durkin
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Viktoria Schmitz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Kevin Hsueh
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Katheryn Ney
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Agarwal AR, Cuero KJ, Stadecker M, Meshram P, Sharma S, Zimmer ZR, Best MJ. Impact of preoperative urinary tract infection on postoperative outcomes following total shoulder arthroplasty for osteoarthritis. Shoulder Elbow 2023; 15:100-110. [PMID: 37692880 PMCID: PMC10492532 DOI: 10.1177/17585732221127590] [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: 06/22/2022] [Revised: 08/13/2022] [Accepted: 09/01/2022] [Indexed: 09/12/2023]
Abstract
Introduction As the utilization of total shoulder arthroplasty (TSA) increases, it is essential to identify risk factors associated with postoperative complications. Urinary tract infection (UTI) is one such example. Our objective is to identify whether UTI is associated with increased rates of prosthetic joint infection (PJI) and determine whether its treatment reduces PJI rates. Methods Patients who underwent primary TSA for glenohumeral osteoarthritis between 2010 and 2019 with minimum two-year follow-up were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were stratified into two cohorts: those with preoperative UTI within two weeks of TSA and those without. The preoperative UTI cohort was stratified into those treated and those untreated prior to TSA. Univariate and multivariable analyses were performed. Results Following multivariable analysis, there were significantly higher odds of postoperative anemia, pulmonary embolism, and death in the UTI cohort. Comparing treated to untreated UTI, there were no significant differences in multivariable analysis for any 90-day medical or two-year surgical complications. Discussion This study showed that UTI was not associated with increased rates of PJI. UTI was, however, associated with postoperative medical complications that surgeons should be aware of.
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Affiliation(s)
- Amil R. Agarwal
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Kendrick J. Cuero
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Monica Stadecker
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Prashant Meshram
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, MD, USA
| | - Sribava Sharma
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, MD, USA
| | - Zachary R. Zimmer
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Matthew J. Best
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, MD, USA
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Suen KFK, Low JXY, Charalambous CP. Urinary tract infection is associated with 2.4-fold increased risk of surgical site infection in hip fracture surgery: systematic review and meta-analysis. J Hosp Infect 2023; 139:56-66. [PMID: 37343771 DOI: 10.1016/j.jhin.2023.06.016] [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: 02/24/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND There is no consensus regarding whether urinary tract infection (UTI) should be screened for or treated in hip fracture patients. AIM To assess the relationship between perioperative UTI and surgical site infection (SSI) in hip fracture patients, and the relationship between urinary catheterization and SSI in these patients. METHODS PubMed, Embase, CINAHL and Cochrane Library were searched to identify studies that evaluated the relationship between perioperative UTI and SSI and/or between urinary catheterization and SSI. Articles were included if they used the term UTI or specified UTI as symptomatic bacteriuria. FINDINGS A total of 4139 records were identified, with eight studies included. Meta-analysis of seven studies which evaluated perioperative UTI and SSI showed an SSI rate of 7.1% (95% confidence interval (CI): 3.8-13.2) among 1217 patients with UTI vs 2.4% (95% CI: 1.0-5.7) in 36,514 patients without UTI (OR: 2.41; 95% CI: 1.67-3.46; P < 0.001). In three studies which specifically defined UTI as symptomatic bacteriuria, the SSI rate among UTI patients was 5.7% (95% CI: 4.0-8.1) vs 1.1% (95% CI: 0.2-5.2) in those without UTI (OR: 3.00; 95% CI: 0.55-16.26; P = 0.20). One study evaluated urinary catheterization and SSI. CONCLUSION Perioperative UTI is associated with a higher risk of SSI among hip fracture patients but the evidence is limited by the heterogeneity in the definition of UTI. We recommend considering the possibility of perioperative UTI in hip fracture patients, with treatment administered as necessary to reduce SSI rates.
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Affiliation(s)
- K F K Suen
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, Lancashire, UK
| | - J X Y Low
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, Lancashire, UK
| | - C P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, Lancashire, UK; School of Medicine, University of Central Lancashire, Preston, Lancashire, UK.
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Sabater-Martos M, Martínez-Pastor JC, Morales A, Ferrer M, Antequera A, Roqué M. Overview of systematic reviews of risk factors for prosthetic joint infection. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:426-445. [PMID: 37116750 DOI: 10.1016/j.recot.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SR) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SR are increasingly frequent, their methodological field presents some knowledge gaps. PURPOSE To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. MATERIAL AND METHODS We conducted a bibliographic search in 4databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. RESULTS Twenty-three SR were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. CONCLUSIONS Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SR are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.
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Affiliation(s)
- M Sabater-Martos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, España.
| | - J C Martínez-Pastor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - A Morales
- Fisioterapia Vestibular, Rehabilitación del Vértigo y el Equilibrio, Fisioterapia del Aparato Locomotor, Barcelona, España
| | - M Ferrer
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - A Antequera
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España
| | - M Roqué
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España
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Sabater-Martos M, Martínez-Pastor JC, Morales A, Ferrer M, Antequera A, Roqué M. [Translated article] Overview of systematic reviews of risk factors for prosthetic joint infection. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T426-T445. [PMID: 37364724 DOI: 10.1016/j.recot.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SRs) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SRs are increasingly frequent, their methodological field presents some knowledge gaps. PURPOSE To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. MATERIAL AND METHODS We conducted a bibliographic search in 4 databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. RESULTS Twenty-three SRs were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8 SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. CONCLUSIONS Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SRs are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.
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Affiliation(s)
- M Sabater-Martos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - J C Martínez-Pastor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Morales
- Fisioterapia Vestibular, Rehabilitación del Vértigo y el Equilibrio, Fisioterapia del Aparato Locomotor, Barcelona, Spain
| | - M Ferrer
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Antequera
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - M Roqué
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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Blanchard NP, Browne JA, Werner BC. The Timing of Preoperative Urinary Tract Infection Influences the Risk of Prosthetic Joint Infection Following Primary Total Hip and Knee Arthroplasty. J Arthroplasty 2022; 37:2251-2256. [PMID: 35598757 DOI: 10.1016/j.arth.2022.05.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The importance of preoperative urinary tract infection (UTI) in total hip and knee arthroplasty (THA and TKA) is controversial. The purpose of this study was to investigate the timing of preoperative UTI diagnosis and association with prosthetic joint infection (PJI) and determine if antibiotics impact this risk. METHODS A national database was used to analyze patients undergoing THA and TKA diagnosed with a preoperative UTI. Timing of diagnosis was categorized by 1-week intervals prior to surgery. Matched cohorts without UTI were collected, and PJI rates within 2 years of surgery were compared. Patients who received antibiotic prescriptions were identified and compared to no prescription. RESULTS Preoperative UTI within 1 week of TKA was associated with higher rates of PJI (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.26-1.43, P < .001). Preoperative UTI within 1 week of THA (OR 1.56, 95% CI 1.44-1.68, P < .001) and between 1-2 weeks prior to THA (OR 1.12, 95% CI 1.02-1.22, P = .022) was associated with significantly higher rates of PJI. UTI diagnosis at any other time interval did not reach statistical significance. Antibiotic prescription was not associated with lower rates of PJI. CONCLUSION Patients with preoperative UTI within 1 week of TKA or within 2 weeks of THA have an increased risk of postoperative PJI. Antibiotics do not appear to mitigate risk. LEVEL OF EVIDENCE Level III; Retrospective, database comparison.
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Affiliation(s)
- Neil P Blanchard
- University of Virginia Health System, UVA Orthopaedic Center Ivy Road, Charlottesville, Virginia
| | - James A Browne
- University of Virginia Health System, UVA Orthopaedic Center Ivy Road, Charlottesville, Virginia
| | - Brian C Werner
- University of Virginia Health System, UVA Orthopaedic Center Ivy Road, Charlottesville, Virginia
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Tella GF, Donadono C, Castagnini F, Bordini B, Cosentino M, Di Liddo M, Traina F. Preoperative and postoperative risk factors for periprosthetic joint infection in primary total hip arthroplasty: A 1-year experience. World J Orthop 2022; 13:903-910. [PMID: 36312522 PMCID: PMC9610863 DOI: 10.5312/wjo.v13.i10.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/27/2022] [Accepted: 09/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) in primary total hip replacement (THR) is one of the most important threats in orthopedic surgery, so one important surgeon's target is to avoid or early diagnose a PJI. Although the incidence of PJI is very low (0.69%) in our department, with an average follow-up of 595 d, this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing. AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection. METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection (0.69%) with a mean follow-up of 596 d (min 30, max 1451). We reviewed all medical records to collect the data: duration and time of the surgery, presence, type and duration of the antibiotic therapy, preoperative diagnosis, blood values before and after surgery, transfusions, presence of preoperative drugs (in particularly anticoagulants and antiaggregant, corticosteroids and immunosuppressants), presence of some comorbidities (high body mass index, blood hypertension, chronic obstructive pulmonary disease, cardiac ischemia, diabetes, rheumatological conditions, previous local infections). RESULTS No preoperative, intraoperative, or postoperative analysis showed a higher incidence of PJI. We did not find any class with evident major odds of PJI. In our study, we did not find any border value to predict PJI and all patients had similar values in both groups (non-PJI and PJI). Only some categories, such as female patients, showed more frequency of PJI, but this difference related to sex was not statistically significant. CONCLUSION We did not find any category with a higher risk of PJI in THR, probably due to the lack of few cases of infection.
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Affiliation(s)
- Giuseppe Ferdinando Tella
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Cesare Donadono
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Michele Di Liddo
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
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Jaenisch M, Wirtz DC. [Patient optimization before hip revision arthroplasty: : How to handle comorbidities]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:619-630. [PMID: 35759042 DOI: 10.1007/s00132-022-04273-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Preoperative optimization of the therapeutic regime of comorbidities can lead to an improvement of the postoperative outcome and has the potential to reduce the financial burden on the health care system in revision hip arthroplasty. Patient-related factors and an increasing incidence of comorbidities lead to a higher risk of implant failure and revision for all causes. Important and potentially modifiable risk factors like preoperative anemia, coagulopathy, infectious disease (dental status, urinary tract infections, colonization with staphylococcus), metabolic conditions (obesity, malnutrition, diabetes mellitus, osteoporosis), and smoking need to be addressed. To achieve an optimal preoperative condition a multidisciplinary approach should be applied.
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Affiliation(s)
- Max Jaenisch
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53129, Bonn, Deutschland.
| | - Dieter Christian Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53129, Bonn, Deutschland
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Hollenbeck BL, Hoffman M, Fang CJ, Counterman K, Cohen S, Bell CA. Elimination of Routine Urinalysis before Elective Orthopaedic Surgery Reduces Antibiotic Utilization without Impacting Catheter-associated Urinary Tract Infection or Surgical Site Infection Rates. Hip Pelvis 2021; 33:225-230. [PMID: 34938692 PMCID: PMC8654593 DOI: 10.5371/hp.2021.33.4.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Routine preoperative urinalysis has been the standard of care for the orthopedic population for decades, regardless of symptoms. Studies have demonstrated antibiotic overuse and low concordance between bacteria cultured from the surgical wound and the urine. Testing and treatment of asymptomatic urinary tract colonization before total joint arthroplasty (TJA) is unnecessary and increases patient risk. We investigated reducing antibiotic use by (1) modifying testing algorithms to target patients at risk, (2) modifying reflex to culture criteria, and (3) providing treatment guidelines. Materials and Methods A pre-post study was conducted to determine identify the impact of eliminating universal urinalysis prior to TJA on surgical site infection (SSI) and catheter-associated urinary tract infection (CAUTI) rates and number of antibiotic prescriptions. Patients who underwent primary hip or knee TJA or spinal fusions from February 2016 to March 2018 were included. Patient data was collected for pre- and post-practice change period (February 2016-October 2016 and August 2017-March 2018). Patient demographics, urinalysis results, cultures, and prescriptions were analyzed retrospectively from every tenth chart in the pre-period and prospectively on all patients in the post-period. Results A total of 4,663 patients were studied. There was a 96% decrease in urinalyses performed (P<0.0001), and a 93% reduction rate in antibiotic utilization (P<0.001). No significant difference in SSI and CAUTI rates was observed (P>0.05). Conclusion The elimination of routine urinalysis before orthopedic surgery resulted in a reduction in antibiotic utilization with no significant change in the SSI or CAUTI rates. Cost savings resulted from reduced antibiotic usage.
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Affiliation(s)
- Brian L Hollenbeck
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Megan Hoffman
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Christopher J Fang
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Kevin Counterman
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Susan Cohen
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Christine A Bell
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA, USA
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12
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Hernández-Hernández D, Padilla-Fernández B, Ortega-González MY, Castro-Díaz DM. Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults. CURRENT BLADDER DYSFUNCTION REPORTS 2021; 17:1-12. [PMID: 34868442 PMCID: PMC8634747 DOI: 10.1007/s11884-021-00638-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 12/14/2022]
Abstract
Purpose of review Our goal was to summarize recent evidence regarding recurrent urinary tract infections and asymptomatic bacteriuria in different adult populations. Recent findings Several research groups are focused on the description of resident bacterial flora in the bladder and urinary dysbiosis in the microbiome era. Even the definitions might change in light of these discoveries. However, the role of urinary microbiome and bacterial interference has still to be determined. Summary Systematic treatment of asymptomatic bacteriuria is not recommended and even classic indications such as asymptomatic bacteriuria in pregnant women are controversial. In fact, its treatment is associated with a higher probability of symptomatic UTI and a higher prevalence of antibiotic-resistant bacteria. Improving the diagnosis of asymptomatic bacteriuria and optimizing the management of recurrent urinary tract infections, especially through non-antibiotics measures, are needed in order to minimise antimicrobial resistance.
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Affiliation(s)
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, La Laguna, Tenerife Spain.,Departamento de Cirugía, Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain
| | | | - David Manuel Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, La Laguna, Tenerife Spain.,Departamento de Cirugía, Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain
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13
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Peng L, Zeng Y, Wu Y, Yang J, Pei F, Shen B. Preoperative bacteriuria positivity on urinalysis increases wound complications in primary total hip arthroplasty regardless of the urine culture result. BMC Musculoskelet Disord 2021; 22:834. [PMID: 34587938 PMCID: PMC8480008 DOI: 10.1186/s12891-021-04725-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Current evidence does not recommend screening urine culture and curing asymptomatic bacteriuria (ASB) before joint arthroplasty. The bacteriuria count on pre-operative urinalysis is a more common clinical parameter. We aimed to investigate whether the bacteriuria count on preoperative urinalysis can increase postoperative wound complications in primary total hip arthroplasty (THA). METHODS We conducted a retrospective study that included patients who underwent primary THA in our institution from 2012 to 2018. We obtained preoperative urinalysis results before THA during the same hospitalization and identified patients with abnormal urinalysis. Receiver operating characteristic (ROC) curves were first generated to evaluate the predicted value of leukocyte esterase (LE), nitrite, bacteriuria, and pyuria in the urinalysis for superficial wound infection. Then, all included patients were divided into two groups according to the preoperative urinalysis: a bacteriuria-positive group and a bacteriuria-negative group. The primary outcome was the superficial wound infection rate within 3 months postoperatively, and the secondary outcomes included wound leakage, prosthetic joint infection (PJI), pulmonary infection, urinary tract infection (UTI), readmission rate within 3 months postoperatively, and length of stay (LOS) during hospitalization. We utilized univariable analyses to compare the outcomes between the two groups. A multivariable logistic regression model was generated to explore the potential association between bacteriuria and the risk of superficial wound infection, wound leakage, and readmission rate controlling for baseline values. RESULTS A total of 963 patients were included in the study. One hundred sixty patients had abnormal urinalysis. The AUCs for LE, nitrite, bacteriuria, and pyuria were 0.507 (95% confidence interval (CI), 0.315 to 0.698), 0.551 (0.347 to 0.756), 0.675 (0.467 to 0.882), and 0.529 (0.331 to 0.728), respectively. Bacteriuria was diagnostically superior to LE, nitrite, and pyuria. Among the 963 patients, 95 had a positive bacteriuria on preoperative urinalysis, and only 9 (9.5%) had a positive urine culture. Compared with the bacteriuria-negative group, the bacteriuria-positive group had a higher superficial wound infection rate (4.2% vs. 0.6%, P = 0.008), higher wound leakage rate (11.6% vs. 4.5%, P = 0.007), higher readmission rate (5.3% vs. 1.3%, P = 0.015) within 3 months postoperatively and longer LOS (6.19 ± 2.89 days vs. 5.58 ± 2.14 days, P = 0.011). After adjustment, the bacteriuria-positive group had a significantly increased risk of superficial wound infection (OR = 7.587, 95%CI: 2.002 to 28.755, P = 0.003), wound leakage (OR = 3.044, 95%CI: 1.461 to 6.342, P = 0.003), and readmission (OR = 4.410, 95%CI: 1.485 to 13.097, P = 0.008). CONCLUSION Preoperative bacteriuria positivity on urinalysis significantly increased the risk of postoperative wound complications, readmission, and LOS in primary THA regardless of the result of the urine culture. Urinalysis is a fast and cost-acceptable test whose advantages have been underestimated. LEVEL OF EVIDENCE Level III, observational study.
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Affiliation(s)
- Linbo Peng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China
| | - Jing Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China
| | - Fuxing Pei
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, China.
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14
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Parkes RJ, Ayeko O, Brunton L, Griffiths-Jones W, Ungvari Z, Goss H. Revolutionising rapid recovery: a quality improvement project in hip and knee replacement. BMJ Open Qual 2021; 10:bmjoq-2020-001249. [PMID: 33879494 PMCID: PMC8061820 DOI: 10.1136/bmjoq-2020-001249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/08/2021] [Accepted: 04/03/2021] [Indexed: 12/25/2022] Open
Abstract
With increasing bed pressures and an ageing population, there is a need to increase throughput and reduce the bed burden of joint replacements. These issues were recognised in North Devon and an enhanced recovery pathway was established. Enhanced recovery, which aims to optimise the patient journey and shorten the inpatient admission, was first adopted for hip and knee replacements in North Devon District hospital in 2011. The Rapid Recovery Group, comprised a multidisciplinary team involved in the perioperative patient pathway, formed in the third financial quarter of 2018/2019 (Q3). The group was tasked with the optimisation of the pathway for patients requiring hip and knee replacement from referral to 12 months postoperation. Representatives from the group visited a similar sized hospital with successful outcomes from their pathway in order to compare and then construct a new pathway based on observed practices. Multiple interventions were instigated, alongside continuous data collection, forming a combination of simultaneous and sequential Plan Do Study Act cycles. Interventions involved intraoperative local anaesthetic injection protocols, use of Taurus frames together with nurse-led mobilisation and trials of simplified drug charts. Information collected included type of surgery, length of stay, who mobilised patients and when. Mean length of stay in total hip and knee replacement has dropped from 3.6 to 2.4 days and 3.6 to 2.0 days respectively, comparing mean for the fiscal year 2018/2019 to 2019/2020, putting the hospital in the top 10 trusts in the country. With multiple changes occurring simultaneously, the impact of individual elements is difficult to isolate but the overall impact of the interventions is evident. A drastic improvement in the length of stay has been seen and the collaborative multidisciplinary approach has been pivotal to success.
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Affiliation(s)
| | - Olusegun Ayeko
- Trauma & Orthopaedics, North Devon District Hospital, Barnstaple, UK
| | - Luke Brunton
- Trauma & Orthopaedics, North Devon District Hospital, Barnstaple, UK
| | | | - Zsolt Ungvari
- Trauma & Orthopaedics, North Devon District Hospital, Barnstaple, UK
| | - Henry Goss
- Trauma & Orthopaedics, North Devon District Hospital, Barnstaple, UK
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15
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Rodríguez-Pardo D, Del Toro MD, Guío-Carrión L, Escudero-Sánchez R, Fernández-Sampedro M, García-Viejo MÁ, Velasco-Arribas M, Soldevila-Boixader L, Femenias M, Iribarren JA, Pulido-Garcia MDC, Navarro MD, Lung M, Corona PS, Almirante B, Pigrau C. Role of asymptomatic bacteriuria on early periprosthetic joint infection after hip hemiarthroplasty. BARIFER randomized clinical trial. Eur J Clin Microbiol Infect Dis 2021; 40:2411-2419. [PMID: 33864153 DOI: 10.1007/s10096-021-04241-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/30/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate preoperative asymptomatic bacteriuria (ASB) treatment to reduce early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture. METHODS Open-label, multicenter RCT comparing fosfomycin-trometamol versus no intervention with a parallel follow-up cohort without ASB. PRIMARY OUTCOME early-PJI after HHA. RESULTS Five hundred ninety-four patients enrolled (mean age 84.3); 152(25%) with ASB (77 treated with fosfomycin-trometamol/75 controls) and 442(75%) without. Despite the study closed without the intended sample size, ASB was not predictive of early-PJI (OR: 1.06 [95%CI: 0.33-3.38]), and its treatment did not modify early-PJI incidence (OR: 1.03 [95%CI: 0.15-7.10]). CONCLUSIONS Neither preoperative ASB nor its treatment appears to be risk factors of early-PJI after HHA. ClinicalTrials.gov Identifier: Eudra CT 2016-001108-47.
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Affiliation(s)
- Dolors Rodríguez-Pardo
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain. .,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.
| | - María Dolores Del Toro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Laura Guío-Carrión
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | - Rosa Escudero-Sánchez
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Fernández-Sampedro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ángel García-Viejo
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Internal Medicine Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - María Velasco-Arribas
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Internal Medicine Department (Infectious Diseases Division), Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Laura Soldevila-Boixader
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Magdalena Femenias
- Orthopedic Surgery Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - José Antonio Iribarren
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Donostia IIS Biodonostia, San Sebastián, Spain
| | | | - María Dolores Navarro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Mayli Lung
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo S Corona
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Septic and Reconstructive Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain
| | - Carles Pigrau
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain
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16
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Schmitt DR, Schneider AM, Brown NM. Impact of Perioperative Urinary Tract Infection on Surgical Site Infection in Patients Undergoing Primary Hip and Knee Arthroplasty. J Arthroplasty 2020; 35:2977-2982. [PMID: 32553793 DOI: 10.1016/j.arth.2020.05.025] [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: 04/13/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The literature lacks clear consensus regarding the association between postoperative urinary tract infection (UTI) and surgical site infection (SSI). Additionally, in contrast to preoperative asymptomatic bacteriuria, SSI risk in patients with preoperative UTI has been incompletely studied. Therefore, our goal was to determine the effect of perioperative UTI on SSI in patients undergoing primary hip and knee arthroplasty. METHODS Using the National Surgical Quality Improvement Program database, all patients undergoing primary hip and knee arthroplasty were identified. Univariate and multivariate regressions, as well as propensity matching, were used to determine the independent risk of preoperative and postoperative UTI on SSI, reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Postoperative UTI significantly increased the risk for superficial wound infection (OR 2.147, 95% CI 1.622-2.842), deep periprosthetic joint infection (PJI) (OR 2.288, 95% CI 1.579-3.316), and all SSIs (superficial and deep) (OR 2.193, 95% CI 1.741-2.763) (all P < .001). Preoperative UTI was not associated with a significantly increased risk of superficial infection (P = .636), PJI (P = .330), or all SSIs (P = .284). Further analysis of UTI present at the time of surgery using propensity matching showed no increased risk of superficial infection (P = 1.000), PJI (P = .624), or SSI (P = .546). CONCLUSION Postoperative UTI was associated with SSI, reinforcing the need to minimize factors which predispose patients to the risk of UTI after surgery. The lack of association between preoperative UTI and SSI suggests that hip and knee arthroplasty can proceed without delay, although initiating antibiotic treatment is prudent and future prospective investigations are warranted.
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Affiliation(s)
- Daniel R Schmitt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL
| | - Andrew M Schneider
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL
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17
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Althoff AD, Chen DQ, Quinlan ND, Werner BC, Browne JA. Urinary Self-Catheterization is Not Associated with Increased Risk of Major Complications Following Total Hip and Knee Arthroplasty. J Arthroplasty 2020; 35:2380-2385. [PMID: 32381445 DOI: 10.1016/j.arth.2020.04.017] [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: 01/11/2020] [Revised: 03/16/2020] [Accepted: 04/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The objective of this study is to evaluate urinary self-catheterization as a potential risk factor for postoperative complications following total hip (THA) and knee (TKA) arthroplasty procedures. METHODS Self-catheterization patients who underwent total joint arthroplasty from 2005 to 2014 were identified in a national insurance database. Rates of death, hospital readmission, emergency room visit, infection, revision, and dislocation for THA or arthrofibrosis for TKA were calculated, as well as cost and length of stay. Self-catheterizing patients were then compared to a 4:1 matched control cohort using a logistic regression analysis to control for confounding factors. RESULTS Sixty-nine patients underwent THA, and 128 patients who underwent TKA and who actively self-catheterized at the time of surgery were identified. Self-catheterization was not associated with infection, emergency room visits, readmissions, revision surgery, arthrofibrosis, or cost compared to the 4:1 matched control cohort. However, self-catheterization was associated with significantly longer length of stay (difference for THA = 1.91 days, confidence interval = 0.97-2.86, P < .001; difference for TKA = 0.61, odds ratio = 0.16-1.06, P = .01). CONCLUSION Self-catheterization does not appear to be associated with increased risk of major complications following total joint arthroplasty with the numbers available in this study. Reassurance can be given regarding concerns for infection and other complications following surgery in this patient population.
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Affiliation(s)
- Alyssa D Althoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Dennis Q Chen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Nicole D Quinlan
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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18
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Garbarino LJ, Gold PA, Anis HK, Sodhi N, Danoff JR, Boraiah S, Rasquinha VJ, Mont MA. Does Intermittent Catheterization Compared to Indwelling Catheterization Decrease the Risk of Periprosthetic Joint Infection Following Total Knee Arthroplasty? J Arthroplasty 2020; 35:S308-S312. [PMID: 32192833 DOI: 10.1016/j.arth.2020.02.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Catheterization for the prophylaxis against or treatment for urinary retention commonly occurs after total knee arthroplasty (TKA). Recent studies have questioned the use of the indwelling catheterization, especially in its potential role as a nidus for infection. We are still unsure of its downstream effects on periprosthetic joint infections (PJIs). Therefore, this study aimed to compare the risks of postoperative PJI following intermittent vs indwelling catheterization after TKA. METHODS Between 2017 and 2019, 15 hospitals in a large health system collected data on patients undergoing TKA. Patient treatments with indwelling catheter only, intermittent straight catheter only, and both indwelling and intermittent straight catheterizations were recorded. Patient demographics, comorbidities, body mass indices, and PJIs were collected from time of surgery to time of data collection at mean 14 months of follow-up. Univariate and multivariate analyses were performed with independent t-tests and multiple linear regression models to compare catheterization treatment types. RESULTS A total of 9123 TKAs were performed, with patients receiving indwelling catheter only (62%, n = 734), intermittent straight catheter only (25%, n = 299), or both indwelling and intermittent catheterizations (13%, n = 160). Univariate analyses showed that PJIs occurred in 1.1% of no-catheter patients and 2.3% of patients treated with bladder catheterization (P = .002). Using multivariate analyses, indwelling catheter use (odds ratio [OR] 2.647, P < .001), diabetes (OR 1.837, P = .005), and peripheral vascular disease (OR 2.372, P = .046) were found to have a statistically significant increased risk for PJIs. The use of intermittent straight catheterization (OR 1.249, P = .668) or both indwelling and intermittent (OR 1.171, P = .828) did not increase the risk for PJIs. CONCLUSION Urinary bladder catheterization is commonly required for prophylaxis against or treatment for urinary retention following TKA. The use of a urinary catheter can provide a potential nidus for infection in these patients. This study found that indwelling catheterization, but not intermittent catheterization, was associated with an increased risk for PJI. Surgeons should therefore limit the duration of catheterization in an effort to decrease the risk for PJI.
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Affiliation(s)
- Luke J Garbarino
- Department of Orthopaedic Surgery, Northwell Health, New York, NY
| | - Peter A Gold
- Department of Orthopaedic Surgery, Northwell Health, New York, NY
| | - Hiba K Anis
- Department of Orthopaedic Surgery, The Cleveland Clinic, Cleveland, OH
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Northwell Health, New York, NY
| | | | | | | | - Michael A Mont
- Department of Orthopaedic Surgery, Northwell Health, New York, NY
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19
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Brink O. Hip fracture clearance: How much optimisation is necessary? Injury 2020; 51 Suppl 2:S111-S117. [PMID: 32081388 DOI: 10.1016/j.injury.2020.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
Patients with hip fractures are typically elderly individuals with several co-morbidities. Upon admission to the hospital, they often present with acute pain, electrolyte disturbances, anaemia, coagulopathy, and delirium. Long waiting times for surgery are associated with increased morbidity and mortality. The balance between the number of clinical tests and optimisation, which may (i.e., fewer complications and better survival) or may not (i.e., more complications and increased mortality due to unnecessary surgical delay) benefit the patient, has been a preoperative challenge. This summary will review existing clinical guidelines and relevant selected studies to evaluate the extent of preoperative optimisation needed prior to hip fracture surgery.
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Affiliation(s)
- Ole Brink
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juel-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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20
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Improving Antimicrobial Use in Adult Outpatient Clinics: the New Frontier for Antimicrobial Stewardship Programs. Curr Infect Dis Rep 2020. [DOI: 10.1007/s11908-020-00722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Zhu X, Sun X, Zeng Y, Feng W, Li J, Zeng J, Zeng Y. Can nasal Staphylococcus aureus screening and decolonization prior to elective total joint arthroplasty reduce surgical site and prosthesis-related infections? A systematic review and meta-analysis. J Orthop Surg Res 2020; 15:60. [PMID: 32075670 PMCID: PMC7031963 DOI: 10.1186/s13018-020-01601-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Nasal Staphylococcus aureus (S. aureus) screening and decolonization has been widely used to reduce surgical site infections (SSIs) prior to total knee and hip arthroplasty (TKA and THA). However, it remains considerably controversial. The aim of this study was to ascertain whether this scheme could reduce SSIs and periprosthetic joint infections (PJIs) following elective primary total joint arthroplasty (TJA). Methods A systematic search was performed in MEDLINE, Embase, and the Cochrane Library until October, 2019. Outcomes of interest included SSI, PJI, superficial infection, and different bacterial species that caused infections. Data from eligible studies were then extracted and synthesized. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated. We also performed additional analyses to evaluate whether there were differences in postoperative SSIs caused by S. aureus or other bacteria. Results Nine studies were included in our meta-analysis. The pooled data elucidated that nasal S. aureus screening and decolonization dramatically mitigated the risk of SSI, PJI, and superficial infection compared to nondecolonization group. The analysis of bacterial species causing infection also showed that the S. aureus infections postoperative were significantly decreased in the decolonization group. However, there was no statistical difference in the SSI caused by other bacteria between the two groups. Conclusion S. aureus screening and decolonization prior to elective primary THA and TKA could significantly decrease the risk of SSI and PJI. However, more robust studies are needed to further evaluate the impact of S. aureus screening and decolonization on infection risk after TJA.
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Affiliation(s)
- Xingyang Zhu
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China.,Yichuan People's Hospital, Jiuchang Road 21#, District Yichuan, Luoyang, Henan, China
| | - Xiaobo Sun
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yuqing Zeng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Wenjun Feng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Jie Li
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Jianchun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China.
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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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