Antibiotic treatment of asymptomatic bacteriuria prior to hip and knee arthroplasty; a systematic review of the literature

Abstract

Background: There is significant debate as to whether routine antibiotic treatment of asymptomatic bacteriuria (ASB) in arthroplasty patients reduces the risk of subsequent PJI. No previous systematic reviews have been undertaken on this subject. The aim of this systematic review was to investigate whether antibiotic treatment of asymptomatic bacteriuria in arthroplasty patients reduces the risk of prosthetic joint infection and to investigate whether the organisms cultured in peri-operative urine samples are the same as those responsible for subsequent prosthetic joint infections.

Methods: Medline and SCOPUS databases were searched using a systematic search strategy. Inclusion Criteria were that the paper must present data detailing infection rates in patients with asymptomatic bacteriuria versus those without and must provide information on infection rates for ASB patients treated with antibiotics versus those not treated. Non-English Language papers and Conference Abstracts in which a full manuscript was not published were excluded. Two hundred and five papers were returned - three papers were included in the review, comprising 3267 patients.

Results: Only 3 studies met the inclusion criteria. The published literature does not support the routine antibiotic treatment of asymptomatic bacteriuria in arthroplasty patients. The organisms responsible for peri-prosthetic joint infection in patients with pre-operative asymptomatic bacteriuria are different from that cultured in their urine during the pre-operative period. This means that, although biologically possible, a direct causal relationship appears extremely unlikely.

Conclusions: The evidence base supporting antibiotic treatment of asymptomatic bacteriuria prior to arthroplasty surgery is weak. Given the lack of evidence to support a direct causal relationship, routine antibiotic treatment of ASB in arthroplasty patients is not justified.

Keywords: Arthroplasty; Bacteriuria; Prosthetic joint infection.