Garcia-Nuño Laura, Villamil Carlos, González-Cuevas Araceli, Martí David, Capilla Silvia, Vives Maria José, Oncins Xavier, Torner Pere, Castellanos Juan, Font-Vizcarra Lluís
Department of Trauma and Orthopaedics, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.
Department of Trauma and Orthopaedics, Corporació Sanitaria Parc Taulí, Barcelona, Spain.
Geriatr Orthop Surg Rehabil. 2017 Mar;8(1):10-13. doi: 10.1177/2151458516681143. Epub 2016 Dec 27.
While preoperative urinary tract infection (UTI) has the potential to cause bacteremia and postsurgical acute prosthetic joint infections (APJIs), the influence of asymptomatic bacteriuria (AB) in these infections remains unclear. So the majority of guidelines not recommend the treatment of AB prior to the surgery. However, as patients with dementia usually cannot explain the symptoms of dysuria, the differential diagnosis between AB and UTI may be very difficult in this group of patients. The principal aim of the study was to compare the rate of positive urine culture at admission in patients with femoral neck fracture with and without dementia and secondarily try to assess the connection of positive urinoculture and postoperative acute gram-negative PJI.
All patients with a femoral neck fracture underwent a urine culture on hospital admission and were prospectively recorded. Variables such as sex, age, institutionalization, dementia and other comorbidities, PJI rate, and in-hospital death were collected. The results of cultures were retrospectively revised. Patients who received postoperative antibiotics or had been diagnosed with UTI during hospital stay were excluded. Statistical comparisons between patients with and without dementia were performed using SPSS software version 17.
A total of 148 patients were included (52 with dementia). The rate of positive urine culture was 32% (n = 16) in patients with dementia and 11.5% in patients without dementia ( = .003). Of these 16 patients with dementia and positive urine culture, 2 (12.5%) developed an acute gram-negative PJI, whereas there were no cases in the group without dementia ( = .011).
The only difference between UTI and AB is the expression of symptoms by the patient. However, as patients with dementia have difficulties to explain UTI symptoms, some UTI may be underdiagnosed.
Patients with dementia have a statistically higher rate of presurgical positive urine culture compared with patients without dementia.
虽然术前尿路感染（UTI）有可能导致菌血症和术后急性人工关节感染（APJI），但无症状菌尿（AB）在这些感染中的影响仍不明确。因此，大多数指南不建议在手术前治疗AB。然而，由于痴呆患者通常无法解释排尿困难的症状，在这组患者中AB和UTI的鉴别诊断可能非常困难。本研究的主要目的是比较有和没有痴呆的股骨颈骨折患者入院时尿培养阳性率，并其次试图评估尿培养阳性与术后急性革兰氏阴性PJI的关联。
所有股骨颈骨折患者入院时均进行尿培养，并进行前瞻性记录。收集性别、年龄、住院情况、痴呆和其他合并症、PJI发生率和住院死亡等变量。对培养结果进行回顾性复查。排除术后接受抗生素治疗或住院期间被诊断为UTI的患者。使用SPSS软件17版对有和没有痴呆的患者进行统计比较。
共纳入148例患者（52例有痴呆）。痴呆患者尿培养阳性率为32%（n = 16），无痴呆患者为11.5%（P = .003）。在这16例痴呆且尿培养阳性的患者中，2例（12.5%）发生了急性革兰氏阴性PJI，而无痴呆组无病例发生（P = .011）。
UTI和AB之间的唯一区别是患者的症状表现。然而，由于痴呆患者难以解释UTI症状，一些UTI可能未被诊断出来。
与无痴呆患者相比，痴呆患者术前尿培养阳性率在统计学上更高。
