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. 2009 Jun;33(3):847-50.
doi: 10.1007/s00264-008-0573-4. Epub 2008 Jun 3.

Asymptomatic urinary tract colonisation predisposes to superficial wound infection in elective orthopaedic surgery

B J Ollivere  1 , N Ellahee, K Logan, J C A Miller-Jones, P W Allen
Affiliations

Asymptomatic urinary tract colonisation predisposes to superficial wound infection in elective orthopaedic surgery

B J Ollivere et al. Int Orthop. 2009 Jun.

Abstract
in English, French

There is no evidence surrounding the benefits, effects or clinical outcomes treating asymptomatic urinary tract colonisation. A series of 558 patients undergoing elective admission for orthopaedic surgery were recruited prior to surgery and were screened for urinary tract infection (UTI). Patients had their urine dipstick tested and positive samples were sent for culture and microscopy. Patients with a positive urine culture were treated with antibiotics prior to surgery; 85% of dipsticks tested were positive, while only 7% of the urine samples were culture positive. Over 36% of patients with a pre-operative UTI show some form of post-operative delayed wound healing or confirmed infection versus 16% in the other subgroup giving a relative risk of wound complications of 2:1 (p < 0.02). We have established that patients who present to pre-admission with urinary tract colonisation are a high risk subgroup for wound infection post-operatively.

L’analyse d’urine est une pratique pré-opératoire habituelle en chirurgie orthopédique. Il n’y a pas d’évidence à traiter, a priori, les infections du tractus urinaires. Méthode: une série de 558 patients admis en chirurgie orthopédique et hospitalisés avant une intervention chirurgicale ont bénéficié d’une analyse urinaire systématique. Les patients présentant des tests positifs ont bénéficié par ailleurs d’une culture et d’un examen au microscope. Les patients présentant des cultures urinaires positives (plus de 105 colonies par mml) ont été traités par antibiotiques avant l’intervention chirurgicale. Résultats: 85% des analyses étaient positives, 7% seulement présentaient des cultures positives. 36% des patients qui avaient une infection urinaire pré-opératoire ont montré, en post-opératoire des problèmes de cicatrisation ou d’infection, versus 16% dans l’autre sous-groupe ceci donnant, pour cet autre sous-groupe un risque relatif de complications profondes de 2/1 (p < 0,02). En conclusion, les cultures d’urine en pré-opératoire doivent être poursuivies chez tous les patients devant bénéficier d’une chirurgie orthopédique d’autant que les patients qui présentaient à l’admission une infection du tractus urinaire étaient à haut risque de complications profondes en post-opératoire.

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Figures

Fig. 1
Fig. 1
Age distribution of sample and subgroups. a Whole sample: number: 558; mean: 61.9; standard deviation: 17.4; skew: -0.73; excess kurtosis: -0.26. b Uncomplicated sample: number: 449; mean: 60.1; standard deviation: 17.0; skew: -0.66; excess kurtosis: -0.31. c Complicated sample: number: 109; mean: 68.4; standard deviation: 17.1; skew: -1.26; excess kurtosis: 0.75
Fig. 2
Fig. 2
Outcome by pre-operative screening status
See this image and copyright information in PMC

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