Wang Chenglong, Yin Dong, Shi Weifa, Huang Wenwen, Zuo Deling, Lu Qiang
Faculty of Graduate Studies, Guangxi University of Chinese Medicine, No.179 Mingxiu Dong Road, Nanning, Guangxi Zhuang Autonomous Region, 530001, China.
Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Nanning, Guangxi Zhuang Autonomous Region, 530001, China.
Int Orthop. 2018 Mar;42(3):479-485. doi: 10.1007/s00264-018-3765-6. Epub 2018 Jan 24.
Many orthopaedic surgeons worry about asymptomatic bacteriuria (ASB) as a possible risk factor for prosthetic joint infection (PJI). However, available evidence establishing a direct link between ASB and PJI is limited. This meta-analysis aimed to investigate whether ASB is a factor for PJI and whether pre-operative antibiotic treatment shows benefit.
We systematically searched major databases such as PubMed, Web of Science, the Cochrane Library and EMBASE for studies. Risk ratio (RR) was calculated for included studies that reported raw counts with 95% confidence interval (CI).
Five studies involved 3588 joint arthroplasties and 441 cases of ASB (overall incidence 12.3%). Compared with the control group, PJI was more common in both patients in the ASB group (RR = 2.87; 95% CI, 1.65-5.00). But in all five studies, the micro-organisms isolated from PJI and urine cultures were not the same. Three of the five studies reported that the antibiotic treated the ASB prior to joint arthroplasty and compared the untreated ASB group.There was no significant difference between groups (RR = 0.89; 95% CI, 0.36-2.20).
PJI occurring via the haematogenous route from the genitourinary tract harbouring bacteria in ASB is impossible. Pre-operative antibiotic treatment has no benefit. A plausible explanation could be an indicator of frailty and increased susceptibility to infection.
ASB increased the risk of PJI in the meta-analysis. However, current evidence does not support systematic antibiotherapy prior to joint arthroplasty and screening for ASB.
许多骨科医生担心无症状菌尿（ASB）可能是人工关节感染（PJI）的一个危险因素。然而，确立ASB与PJI之间直接联系的现有证据有限。本荟萃分析旨在调查ASB是否为PJI的一个因素，以及术前抗生素治疗是否有益。
我们系统检索了主要数据库，如PubMed、科学网、考克兰图书馆和EMBASE，以查找相关研究。对报告原始计数的纳入研究计算风险比（RR），并给出95%置信区间（CI）。
五项研究涉及3588例关节置换术和441例ASB病例（总发生率12.3%）。与对照组相比，ASB组患者发生PJI的情况更常见（RR = 2.87；95% CI，1.65 - 5.00）。但在所有五项研究中，从PJI和尿培养中分离出的微生物并不相同。五项研究中的三项报告称，在关节置换术前用抗生素治疗ASB，并与未治疗的ASB组进行了比较。两组之间无显著差异（RR = 0.89；95% CI，0.36 - 2.20）。
ASB中携带细菌的泌尿生殖道通过血行途径发生PJI是不可能的。术前抗生素治疗并无益处。一个合理的解释可能是虚弱的一个指标以及对感染易感性增加。
在荟萃分析中，ASB增加了PJI的风险。然而，目前的证据不支持在关节置换术前进行系统性抗生素治疗以及筛查ASB。
