title: Genitourinary Procedures as Risk Factors for Prosthetic Hip or Knee Infection: A Hospital-Based Prospective Case-Control Study.
abstract: Background.  The purpose of this study was to determine the risk of prosthetic joint infection (PJI) as a complication of routine genitourinary (GU) procedures in patients with total hip arthroplasty (THA) or total knee arthroplasty (TKA) and to study the impact of antibiotic prophylaxis administered prior to these procedures. Methods.  We conducted a prospective, single-center, case-control study between December 1, 2001 and May 31, 2006. Case patients were hospitalized with total hip or knee PJI. Control subjects underwent a THA or TKA and were hospitalized during the same period on the same orthopedic floor without a PJI. Data regarding demographic features and potential risk factors were collected. The outcome measure was the odds ratio (OR) of PJI after GU procedures performed within 2 years of admission. Results.  A total of 339 case patients and 339 control subjects were enrolled in the study. Of these, 52 cases (15%) and 55 controls (16%) had undergone a GU procedure in the preceding 2 years. There was no increased risk of PJI for patients undergoing a GU procedure with or without antibiotic prophylaxis (adjusted OR [aOR] = 1.0, 95% confidence interval [CI] = 0.2-4.5, P = .95 and aOR = 1.0, 95% CI = 0.6-1.7, P = .99, respectively). Results were similar in a subset of patients with a joint age less than 6 months, less than 1 year, or greater than 1 year. Conclusions.  Genitourinary procedures were not risk factors for subsequent PJI. The use of antibiotic prophylaxis before GU procedures did not decrease the risk of subsequent PJI in our study.
authors.affiliation: Division of Infectious Diseases.
authors.forename: Arjun
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Division of Infectious Diseases.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Osmon
authors.affiliation: Departments of Orthopedic Surgery.
authors.forename: Arlen D
authors.initials: AD
authors.lastname: Hanssen
authors.affiliation: Urology.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Lightner
authors.affiliation: Division of Infectious Diseases.
authors.forename: Walter R
authors.initials: WR
authors.lastname: Wilson
authors.affiliation: Division of Infectious Diseases.
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.affiliation: Division of Infectious Diseases.
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.affiliation: Health Sciences Research , Mayo Clinic College of Medicine , Rochester, Minnesota.
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.affiliation: Health Sciences Research , Mayo Clinic College of Medicine , Rochester, Minnesota.
authors.forename: Jay N
authors.initials: JN
authors.lastname: Mandrekar
authors.affiliation: Division of Infectious Diseases.
authors.forename: Elie F
authors.initials: EF
authors.lastname: Berbari
keywords: antibiotic prophylaxis; genitourinary procedures; prosthetic joint infection