Orthopaedic Subspecialty Research Centre (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran.
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA.
Arch Orthop Trauma Surg. 2024 Dec;144(12):5205-5216. doi: 10.1007/s00402-024-05415-1. Epub 2024 Jul 15.
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.
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.
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]).
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.
全关节置换术（TJA）是一种常见的手术，可提高严重关节炎患者的生活质量。TJA 的需求不断增加，给全球医疗系统带来了巨大的财务压力，而术后因假体周围关节感染（PJI）等并发症再次入院的情况则加剧了这一压力。我们进行了系统评价和荟萃分析，以确定无症状菌尿（ASB）是否会增加感染风险。
我们在三个数据库中进行了搜索：PubMed、Scopus 和 Web of Science。按照 PRISMA 指南进行了筛选步骤。该研究重点关注接受 TJA 且存在 ASB 的患者。两名审查员独立筛选、评估质量并提取数据。使用 Mantel-Haenszel 方法进行荟萃分析。
经过全文筛选，共有 12 项研究被认为符合纳入系统评价的标准，共纳入 42592 名患者。与对照组相比，TJA 患者存在 ASB 时，PJI 的发生率更高（OR [95%CI] = 3.47 [1.42-8.44]）。然而，导致 PJI 的微生物与 ASB 尿液培养中鉴定的微生物不同。此外，分析表明，ASB 的术前抗生素治疗并不会显著影响随后发生 PJI 的风险（OR [95%CI] = 1.00 [0.42-2.39]）。与手术部位感染（SSI）不同，两组之间的发生率没有差异，TJA 患者存在 ASB 时更有可能发生浅表伤口感染（OR [95%CI] = 3.81 [2.02-7.21]）。
本综述和荟萃分析证实，ASB 与 TJA 患者 PJI 和浅表感染的风险增加相关。然而，ASB 与 PJI 微生物之间没有发现关系，这让人怀疑 ASB 微生物是否是 TJA 后感染的直接原因。
