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Review
. 2024 May 27;36(3):275-283.
doi: 10.4103/tcmj.tcmj_309_23. eCollection 2024 Jul-Sep.

Do urinary tract infections affect the rate of periprosthetic joint infections in patients who underwent arthroplasty surgery? A systematic review and meta-analysis

Antoninus Hengky  1   2 , Malvin Tandry  2 , Kevin Gracia Pratama  2 , Pauliana Pauliana  2 , Christopher Kusumajaya  3 , Astrawinata Guatama  4
Affiliations
Review

Do urinary tract infections affect the rate of periprosthetic joint infections in patients who underwent arthroplasty surgery? A systematic review and meta-analysis

Antoninus Hengky et al. Tzu Chi Med J. .

Abstract

Periprosthetic joint infection (PJI) is a significant issue in orthopedic surgery. Urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB) have been identified as potential causes of PJI; however, evidence is inconclusive. Understanding these relationships is critical for improving therapy and patient outcomes. A systematic review was performed by conducting searches from PubMed, EBSCO, ProQuest, and manual searching with adherence to the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 guideline. Studies that reported UTI/ASB and PJI were included. Meta-analysis was conducted using a random-effects model using RevMan 5.4 software. A total of 14 studies were included with UTIs and ASB showed an overall association with increased risk of PJI (odds ratio [OR]: 1.84, 95% confidence interval [CI]: 1.14-2.99, P = 0.01). However, subgroup analysis for UTIs and ASB was not significant. Further analysis of UTIs in total hip arthroplasty (THA) surgery showed a significant association (OR: 1.76, 95% CI: 1.57-1.96) with PJI. Preoperative UTIs timing between 0 and 2 weeks before surgery showed an increased risk of PJI (OR: 1.45, 95% CI: 1.35-1.55). Antibiotic treatment in ASB did not significantly impact PJI rates. Urine and PJI sample cultures in four studies showed no correlation of microorganisms between the two sites. According to recent evidence, a statistically significant association was found between UTIs and PJI in patients who underwent THA surgery. However, ASB did not yield significant results in relation to PJI. These results should be supported by larger and well-designed studies to make proper clinical suggestion in future. For further research, it is recommended to adopt standardized criteria for outcome measurement and to involve larger sample sizes to enhance the reliability and generalizability of findings.

Keywords: Arthroplasty; Asymptomatic bacteriuria; Periprosthetic joint infection; Urinary tract infection.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Review and Meta-Analysis flow diagram 2020
Figure 2
Figure 2
Forest plot of risk of periprosthetic joint infection based on the presence of urinary tract infections or asymptomatic bacteriuria. CI: Confidence interval, OR: Odds ratio, ASB: Asymptomatic bacteriuria, UTI: Urinary tract infection
Figure 3
Figure 3
Forest plot of risk of periprosthetic joint infection based on the presence of urinary tract infections in total hip arthroplasty surgery. CI: Confidence interval, OR: Odds ratio, UTI: Urinary tract infection
Figure 4
Figure 4
Forest plot of risk of periprosthetic joint infection based on the presence of preoperative urinary tract infections (0–2 weeks) in total joint arthroplasty. CI: Confidence interval, OR: Odds ratio, UTI: Urinary tract infection
Figure 5
Figure 5
Funnel plot of risk of periprosthetic joint infection and urinary tract infections. CI: Confidence interval, OR: Odds ratio
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