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Significance of Asymptomatic Bacteriuria (bladder infection) in Knee and Hip Arthroplasty

Josephine

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Significance of Asymptomatic Bacteriuria (bladder infection) in Knee and Hip Arthroplasty POSTER NO. P058
Arup K. Bhadra, MD, Mahwah, NJ
Jared Armstrong, MD, Prospect, KY
Cameron A. Ghazi, BS, Prospect, KY
Arthur L. Malkani, MD, Louisville, KY
Madhusudhan R. Yakkanti, MD, Louisville, KY


INTRODUCTION: Infection is one of the most devastating and dreaded complications of total joint arthroplasty. The incidence and significance of asymptomatic bacteriuria in patients for hip and knee arthroplasty is unknown. The purpose of the study was to report the incidence of bacteriuria and results of arthroplasty in respect to periprosthetic infection.

METHODS: This was a retrospective review of 400 consecutive patients (155 male, 245 female) with mean age of 65.6 years (43-89) undergoing knee and hip arthroplasty. Patients were evaluated for immediate preoperative urine microscopy results for bacteria, nitrite and leucocytes, co-morbidities, peri-operative treatment for urinary tract infection, postponement of surgery and periprosthetic infection. The mean follow up was 17 months (6-24). All patients had perioperative urinary catheterization for 24 hours.

RESULTS: The incidence of bacteriuria was 43% with nitrite positive 20% and leucocyte positive 24.7%. Female to male incidence ratio was 1:9. There was 23% incidence of bacteriuria under 65 years of age. Diabetes was the most common (9.2%) co-morbidity, followed by renal disease (4.5%). Surgery was postponed in three patients (0.07%) with 3+ bacteriuria and large leucocytes until urine culture result was negative following oral antibiotic treatment. Of three periprosthetic infections, two underwent debridement and polyethylene exchange and one had two staged revision knee arthroplasty. Two of the infections had negative urine microscopy, but positive for diabetes and HIV. The other one periprosthetic infection had positive urine microscopy, but negative urine culture.

DISCUSSION AND CONCLUSION: Asymptomatic bacteriuria is common even in younger patients and especially female. Postponement of surgery should be considered only if significant other co-morbidities and other signs of cystitis/pyelonephritis are present.
 

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