Sousa Ricardo, Muñoz-Mahamud Ernesto, Quayle Jonathan, Dias da Costa Luis, Casals Cristina, Scott Phylip, Leite Pedro, Vilanova Paz, Garcia Sebastian, Ramos Maria Helena, Dias Joana, Soriano Alex, Guyot Andrea
Departments of Orthopaedics.
Department of Orthopaedics, Bone and Joint Infection Unit.
Clin Infect Dis. 2014 Jul 1;59(1):41-7. doi: 10.1093/cid/ciu235. Epub 2014 Apr 9.
Infection is a major complication after total joint arthroplasty. The urinary tract is a possible source of surgical site contamination, but the role of asymptomatic bacteriuria (ASB) before elective surgery and the subsequent risk of infection is poorly understood.
Candidates for total hip or total knee arthroplasty were reviewed in a multicenter cohort study. A urine sample was cultured in all patients, and those with ASB were identified. Preoperative antibiotic treatment was decided on an individual basis, and it was not mandatory or randomized. The primary outcome was prosthetic joint infection (PJI) in the first postoperative year.
A total of 2497 patients were enrolled. The prevalence of ASB was 12.1% (303 of 2497), 16.3% in women and 5.0% in men (odds ratio, 3.67; 95% confidence interval, 2.65-5.09; P < .001). The overall PJI rate was 1.7%. The infection rate was significantly higher in the ASB group than in the non-ASB group (4.3% vs 1.4%; odds ratio, 3.23; 95% confidence interval, 1.67-6.27; P = .001). In the ASB group, there was no significant difference in PJI rate between treated (3.9%) and untreated (4.7%) patients. The ASB group had a significantly higher proportion of PJI due to gram-negative microorganisms than the non-ASB group, but these did not correlate to isolates from urine cultures.
ASB was an independent risk factor for PJI, particularly that due to gram-negative microorganisms. Preoperative antibiotic treatment did not show any benefit and cannot be recommended.
感染是全关节置换术后的主要并发症。尿路是手术部位污染的一个可能来源，但择期手术前无症状菌尿（ASB）的作用以及随后的感染风险尚不清楚。
在一项多中心队列研究中对全髋关节或全膝关节置换术的候选者进行了评估。对所有患者的尿液样本进行培养，确定存在ASB的患者。术前抗生素治疗根据个体情况决定，并非强制或随机进行。主要结局是术后第一年的人工关节感染（PJI）。
共纳入2497例患者。ASB的患病率为12.1%（2497例中的303例），女性为16.3%，男性为5.0%（优势比，3.67；95%置信区间，2.65 - 5.09；P <.001）。总体PJI发生率为1.7%。ASB组的感染率显著高于非ASB组（4.3%对1.4%；优势比，3.23；95%置信区间，1.67 - 6.27；P =.001）。在ASB组中，接受治疗的患者（3.9%）和未接受治疗的患者（4.7%）的PJI发生率无显著差异。ASB组因革兰氏阴性微生物导致的PJI比例显著高于非ASB组，但这些与尿液培养分离株无关。
ASB是PJI的独立危险因素，尤其是由革兰氏阴性微生物引起的PJI。术前抗生素治疗未显示出任何益处，不建议使用。
