Schmitt Daniel R, Schneider Andrew M, Brown Nicholas M
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL.
J Arthroplasty. 2020 Oct;35(10):2977-2982. doi: 10.1016/j.arth.2020.05.025. Epub 2020 May 21.
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.
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).
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).
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.
关于术后尿路感染（UTI）与手术部位感染（SSI）之间的关联，文献中缺乏明确的共识。此外，与术前无症状菌尿症不同，术前UTI患者的SSI风险尚未得到充分研究。因此，我们的目标是确定围手术期UTI对接受初次髋膝关节置换术患者SSI的影响。
利用国家外科质量改进计划数据库，识别所有接受初次髋膝关节置换术的患者。采用单因素和多因素回归分析以及倾向匹配法，确定术前和术后UTI对SSI的独立风险，以比值比（OR）及95%置信区间（CI）表示。
术后UTI显著增加了浅表伤口感染风险（OR 2.147，95% CI 1.622 - （此处原文有误，应为2.842）2.842）、深部假体周围关节感染（PJI）风险（OR 2.288，95% CI 1.579 - 3.316）以及所有SSI（浅表和深部）风险（OR 2.193，95% CI 1.741 - 2.763）（所有P < .001）。术前UTI与浅表感染风险显著增加无关（P = .636）、PJI风险无关（P = .330）或所有SSI风险无关（P = .284）。使用倾向匹配法对手术时存在的UTI进行进一步分析显示，浅表感染风险（P = 1.000）、PJI风险（P = .624）或SSI风险（P = .546）没有增加。
术后UTI与SSI相关，这进一步强调了需要尽量减少使患者术后易患UTI的因素。术前UTI与SSI之间缺乏关联表明，髋膝关节置换术可以立即进行，尽管开始抗生素治疗是谨慎的，并且有必要进行未来的前瞻性研究。
