What is the role of catheter antibiotic prophylaxis for patients undergoing joint arthroplasty?
BACKGROUND
Antimicrobial prophylaxis at the time of urinary catheter insertion and removal is commonly administered in patients undergoing joint arthroplasty, despite the lack of evidence to support this practice. The rationale is the theoretical risk of prosthetic joint infection arising from bacterial seeding from the urinary tract at the time of catheterization. In an era of antimicrobial stewardship, further assessment is warranted.


METHODS
This study aimed to investigate the incidence of catheter-associated (CA) bacteriuria and bacteraemia in patients undergoing total joint arthroplasty and to assess the antimicrobial susceptibility of any isolated microorganisms. This prospective observational study undertaken over a 6-month period (May to October 2014) included 99 patients undergoing elective primary hip and knee arthroplasty at St Vincent's Hospital, Melbourne. Urine specimens were collected at insertion and removal of urinary catheters along with blood cultures upon urinary catheter removal.


RESULTS
Overall 98% of the cohort received catheter antimicrobial prophylaxis for urinary catheter insertion and removal; the majority of patients received gentamicin (94%). Bacteriuria on catheter insertion had an incidence of 4.4%. The incidence of CA bacteriuria was 1.3%. All cultured organisms were sensitive to commonly used antibiotics including cephazolin. There were no cases of bacteraemia with urinary catheter removal. Increasing age, American Society of Anesthesiologists status and female gender were associated with the development of bacteriuria.


CONCLUSIONS
The incidence of CA bacteriuria and bacteraemia with antimicrobial prophylaxis is low. This study provokes discussion about the requirement of catheter prophylaxis in this surgical context and the utility of preoperative urine screening.
Medical School, University of Notre Dame, Sydney, New South Wales, Australia.|Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Rose-Marie
RM
Scarlato
Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.|Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
Michelle M
MM
Dowsey
Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Victoria, Australia.
Kirsty L
KL
Buising
Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.|Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
Peter F M
PF
Choong
Department of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.|Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
Trisha N
TN
Peel
D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016470:Bacteremia / Q000097:blood / Q000209:etiology* / Q000517:prevention & control / Q000652:urine; D001437:Bacteriuria / Q000097:blood / Q000209:etiology* / Q000517:prevention & control / Q000652:urine; D002408:Catheters, Indwelling / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D014546:Urinary Catheterization / Q000009:adverse effects / Q000379:methods*
D000900:Anti-Bacterial Agents; D005839:Gentamicins
antibiotic prophylaxis; arthroplasty; bacteriuria; orthopaedic surgery