Preoperative asymptomatic bacteriuria in patients undergoing total joint arthroplasty in South Africa

• Published in: SA Orthopaedic Journal Vol. 20; no. 4; pp. 202 - 206
• Main Authors: Maharaj, Zia, Pillay, Tristan, Mokete, Lipalo, Pietrzak, Jurek RT
• Format: Journal Article
• Language: English
• Published: Johannesburg Medpharm Publications 01.11.2021
• Subjects: Asymptomatic; Asymptomatic bacteriuria; Developing countries; Developing country; HIV; Human immunodeficiency virus; Joint surgery; LDCs; Microorganisms; periprosthetic joint infection; total hip arthroplasty; total knee arthroplasty; Urinalysis; South Africa
• ISSN: 2309-8309; 1681-150X; 1681-150X; 2309-8309
• DOI: 10.17159/2309-8309/2021/v20n4a2

Background Periprosthetic joint infections (PJIs) are a leading cause of revision for total hip arthroplasty (THA) and total knee arthroplasty (TKA), worldwide. Asymptomatic bacteriuria (ASB) is an independent risk factor for PJIs; however, a paucity of data relevant to developing countries exists. The aim of this study was to describe the prevalence of preoperative ASB and the subsequent incidence of PJIs in patients undergoing total joint arthroplasty (TJA) in South Africa.Methods We retrospectively reviewed primary THA and TKA patients. All patients were screened for ASB preoperatively. Patients with positive urinalysis for ASB were identified and treated prior to surgery (treated-ASB). The primary outcome was ASB prevalence and the incidence of PJIs and other perioperative complications. Secondary outcomes included risk factors for ASB and subsequent PJIs in treated-ASB patients, respectively, compared to those with no evidence of ASB (non-ASB). Lastly, we aimed to compare the infective microorganisms cultured from preoperative urinalysis and perioperative sampling of PJIs.Results We included 179 patients (67 THA; 80% female) with mean follow-up of 2.45 years. ASB prevalence was 22% (n = 39). Patients older than 70 years were 3.5 times more likely to have ASB compared to younger patients (p = 0.005). The prevalence of ASB was 22% (n = 10) for human immunodeficiency virus (HIV) positive and 22% (n = 29) for HIV-negative patients (p = 0.084). PJI incidence was 8% (n = 3) in the treated-ASB and 1% (n = 1) in non-ASB. Treated-ASB patients had an 11.6-fold increased likelihood of PJIs than non-ASB patients (p = 0.046). PJI microorganisms cultured did not correlate to isolates from urine cultures.Conclusion The prevalence of ASB in a TJA population in South Africa is 22% which is higher than reported findings worldwide. Although the value of preoperative antibiotic therapy for ASB remains controversial, there is a role for routine urinalysis preoperatively to identify patients predisposed to PJI. This is of specific significance in the management of HIV-positive patients and in developing countries to guide healthcare providers in resource-constrained environments.Level of evidence Level 2